WLE with margin preferred, no amputation for group IV setting. The rest get incisional or core Bx (orbit, PM H&N).

Sentinel LN Bx should be done for extremity sites.

Needle Bx or open Bx can be done; an aggressive LN sample is most appropriate.

Definitive surgery can be carried out after initial Bx or noncancer surgery. This subsequent PRE is followed by local adj therapy based on pathology from the definitive PRE.

A subsequent delayed resection can be done after chemo and RT (for initial Bx only) if the tumor has diminished enough to make resection feasible. SLS takes place on wk 13 (except orbit, PT).

If residual tumor persists after SLS, subsequent-look procedures can be done after further therapy, if the tumor appears resectable. SLS should be done to max extent if it is cosmetically and functionally feasible.

H&N sites: no neck dissection unless there is clinical involvement.

PrT: Only ipsi RP LN dissection should be done. Do not do radical bilat regional node dissection. Regional LNs are ipsi iliac and RP nodes up to the hilum of the ipsi kidney. Orchiectomy and resection of the entire spermatic cord is via inguinal excision. Bx can take place prior to excision (but must ensure there is no spillage).

GU (bladder/prostate): if laparotomy is preformed, then iliac/para-aortic node sample should be done, and any other clinically involved site(s) should be biopsied. Bladder preservation rate is 50%-60%. Partial cystectomy should be done for bladder dome tumors.

Elective LND is not indicated except for extremities and PT lesions. Open Bx or LN sampling should be done for any gross enlarged nodes.