How would you evaluate the role for adjuvant radiation in a very young female (20s) with a localized vulvar SCC, HPV independent, status post hemivulvectomy?

Either re-excision or observation provided no dVin at margin and at least a 3 mm negative margin for invasive disease.

HPV-independent SCC in a young patient is a poor prognostic factor, therefore, I would be inclined to offer some kind of additional treatment. Anecdotally, I have offered observation, only to then react to recurrent disease.

However, would need to better understand close margin - is it 1 mm? 3 mm o...

I'm not sure what VBT (Vaginal BrachyTherapy) would have to do with management of vulvar SCC, unless the acronym is something else.

I would be hesitant to do post-op EBRT in this scenario. If re-excision is feasible, as per Dr. @Dr. First Last's notes on margin status, that would be preferable. A qu...