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...

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 ...

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.