In patients with perianal squamous cell carcinoma extending to the vulva, would you cover the entire vulva or would generous margins on the gross disease suffice?

I would generally favor treating with generous margins as opposed to intentionally covering the entire vulva. However, for patients who have a prior history of vulvar lichen sclerosis or vulvar intraepithelial neoplasia where the risk of developing vulvar cancer is higher, I would consider covering the entire vulva depending on the clinical situation, particularly, if most of the vulva is in the treatment field anyway. In reality, the generous margins that are required will likely cover a large ...

I agree with Dr. @Dr. First Last's response. I would manage this perianal SCC like an anal canal cancer - with generous margins and without inclusion of the entire vulva. As stated above, 2.5 cm margins were used in clinical trials including RTOG 98-11 and RTOG 0529, which is already quite generous. A PET/CT may be useful in this case, in addition to a clinical exam, to ensure full coverage of all gross disease. As this area may not auto-bolus (unlike a tumor limited to the anal canal/anal verge...

Agree with the previous answers. These are sometimes challenging presentations with lots of nuances. In the perianal squamous cell carcinoma patients who do not have involvement of the anal canal, I would include generous margins on the lesion including into the anal canal, but I would not treat the pelvic LNs, and would include instead, just the inguinal LNs. I would consider concurrent daily Cape. I completely agree with the documentation of doses received by the perianal skin with TLDs or dio...

I would also agree with previous answers by @Dr. First Last and @Dr. First Last and one has to perform a careful clinical exam of the peri-anal skin and vulva to identify VIN, lichen sclerosis, and extent of the tumor. I would consider covering the entire vulva (but not the mons).

Also use of TLD on the first fraction is very useful.