What nodal volumes would you cover for a melanoma of the posterior scalp with poor response to immunotherapy, s/p wide excision and occipital nodal dissection with multiple positive nodes and ENE?

With multiple involved nodes and no pathologic response to neoadjuvant immunotherapy, I would suggest adjuvant radiotherapy. I would target the suboccipital, postauricular, and posterior cervical lymphatics (2B, 5B). If the tumor was midline, I would cover bilaterally, and if it was well lateralized...

I suggest looking at the nodal bed and covering it. Coverage of the nodal bed, as shown by clips and abnormal nodes on pre-operative imaging, is wise. Likely, the primary site will need consideration. Melanoma can behave unpredictably. Ensure that pre-radiotherapy imaging is recent, as this patient ...

Let us review some issues: what constitutes risk; where does this disease spread; what benefits and risks exist.

1. "High-risk features include extranodal spread of melanoma, more than two positive lymph nodes, large nodal size, or recurrent disease in previously dissected nodal basin." This statement ...