How would you manage eccrine porocarcinoma of the great toe with positive superficial groin and pelvic lymph nodes s/p toe amputation and pelvic lymph node dissection?

Eccrine porocarcinoma (EPC) is an aggressive but rare skin malignancy, let alone one occurring at the great toe! A meta-analysis (Salih et al., PMID 28721214) of worldwide reports on EPC prior to 2016 offered a good overview of the disease’s natural history. It was noted that 31% had metastasis upon presentation, while regional lymphatics remain the most frequent (57.7%) among all metastatic sites. A recent case report for EPC (Le et al., PMID 34177519) included some references pertaining mostly to systemic drug treatment experiences, while likewise for radiation therapy publications are sporadic (e.g. Zeidan et al., PMID 20492705). Therefore, I would offer the same thoughts as I have given when asked previously to respond to other theMedne...