How would you treat a late local recurrence of extramammary Paget's disease of the vulva, not amenable to resection?

If the patient does not have any invasive disease, or underlying malignancy or nodes, then I would consider treating this with radiation, specifically superficial brachytherapy.

At our institution, we routinely treat similar patients with large perineal, inguinal EMPD patients with 3D custom printed...