What doses would you treat the primary and lymph nodes in node positive vulvar cancer patient with incidentally found focal SCC in a field of VIN3?

I would treat the primary and inguinal nodes if no additional surgery and SNLN planned.

Dose to primary is a function of microscopic or macroscopic disease left behind: 54-56 Gy if microscopic but 60 or above if macroscopic.

Not a simple question to answer with the available information but will try. Unusual to have so much nodal disease in a patient with just focal invasion in VIN3, so I would worry that there is residual invasive disease. Was there invasive disease near the margins of the excision? VIN3 that could be ...