Hello dear.Local control of in-transit metastasis should be achieved with Mohs surgical technique or some other surgical method where surgical margins are rigorously evaluated for residual tumor, perineural extension or intravascular invasion. (e.g. excision with intraoperative frozen section control or excision with postoperative margin assessment). Post operative radiation should be strongly considered. The radiation field often involves the primary tumor site, the in-transit metastatic site, and the draining lymph node basin. Other treatments or diagnostic procedures that can be considered include: Sentinal lymph node biopsy Reduction/alteration in immunosuppressive regimen