How would you palliate a large, symptomatic vaginal melanoma recurrence with limited small pelvic lymph node metastases?   

In the event of recurrence, pre-treatment workup should include a full body PET scan and MRI brain with and without contrast to look for a sanctuary site in the brain. It goes without saying that a clinical trial would be ideal for a patient like this. In the absence of a clinical trial, there are t...

Palliation. Treat problems that are symptomatic. No expensive systemic work up. Pall RT to the pelvis if it’s symptomatic. 30 Gy/10 fractions, 25 Gy/5 fractions, or 20 Gy/2 fractions with a 1 week inter-fraction interval. Apologize for the lengthy response. 

Vaginal melanoma is very difficult to resect without exenterative procedures. And I would not resect if bladder and/or rectal resection is needed. Would re-treat with IO (dual vs single agent is debated). We would also discuss hypofractionated RT to pelvis and with that give single agent pembro. We ...