How do you treat a positive margin of vulvar Paget's after radical vulvectomy?

Assuming this is a microscopically-positive margin, I recommend observation after vulvectomy. In most studies, margin status does not correlate strongly with recurrence risk.

Our retrospective review of Mayo Clinic data suggested that negative margin status may be associated with a lower risk of recurrence among patients who underwent Mohs surgery for extramammary Paget’s disease, but re-excision is typically not recommended for microscopically positive margins, especially if the resection would be associated with increased morbidity due to proximity to vital structures.

I do recommend Mohs surgery when possible to obtain negative margins and hopefully decrease recurrence, but since EMPD is usually non-invasive and not life-threatening, thi...