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

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.

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 ...

Could also consider a 48/20 regimen as per TROG with consideration of dose escalation to gross disease to 55-60 Gy/20 as feasible. I worry a touch about hypofractionating too much around sensitive vaginal, vulvar, and perianal tissues.

Expecting systemic therapy alone to control a 10 cm primary mela...

I think it would be reasonable to knock back the gross disease before starting/resuming systemic therapy. I personally like 6 Gy x 5 treated twice per week as per Dr. Ang's postoperative regimen, and would treat the main lesion and, if possible, any suspicious nodes, after which time I'd refer them ...