Management and prognosis of merkel cell carcinoma of the eyelid

Predicting the Surgical Margin of Resection in Periocular Cutaneous Neoplasms and the Significance of Reconstruction Following Mohs Micrographic Surgery

“…However, these tumors were not exclusively periorbital. 20 This suggests that the unique features of the eyelid skin, such as its thickness and lack of subcutaneous fat, may result in different tumor characteristics when compared with skin in other areas. Because of how the margin is calculated in this study, individual differences in skin tone, tumor location, and tumor depth make it possible that the MOR calculation in this study may overestimate the size of the actual surgical margin due to elastic spreading of the wound that occurs after excision, resulting in an larger measurable defect.…”

“…3,[13][14][15][16][17][18] Wide surgical excision with or without the use of prophylactic elective lymph node dissection, radiotherapy, or chemotherapy may be considered the more accepted practice for these more aggressive tumors. 3,[19][20][21][22] Many reports have described the use of a 2 mm to 5 mm margin of resection (MOR) for treatment of periocular nonmelanoma skin cancers. [23][24][25][26] Chalfin et al 27 reported that standard 3 mm to 4 mm MOR may be inadequate for complete excision of BCCAs in up to 54% of tumors, suggesting that the required MOR is greater than anticipated in a significant percentage of tumors.…”

Management of malignant and benign eyelid lesions

“…because of the elevated risk of clinical misdiagnosis. Most authors agree that wide surgical excision, with 5 mm clear margins, followed by frozen-section control of the margins, confirmed in definitive paraffin sections, is the gold standard for the management of Merkel cell carcinoma [29,30]. A recent report on Merkel cell carcinomas affecting the head and neck region indicated that surgery plus local adjuvant irradiation, even in presence of free surgical margins, is associated with significantly lower rates of local and regional recurrence of Merkel cell carcinoma than surgery alone [31 ].…”

“…The duration of symptoms is relatively short and the tumor shows a rapid growth pattern to a significant size (>10 mm) within 2-3 months. It is often clinically confused with other periocular neoplasms, such as BCC, cyst or chalazion, because of its low incidence [29]. A biopsy should be performed to avoid inappropriate surgical procedures (curettage, cauterization, etc.)…”

Controversies in Sentinel Lymph Node Biopsy for Ocular Neoplasms

“…21 In another study that examined 14 patients with primary Merkel cell carcinoma, it was found that 21% had lymph node involvement on initial presentation, and the mortality rate was 7%. 22 It is currently debatable whether patients with palpable or detectable lymphadenopathy on imaging should proceed with empiric radiation therapy and/or complete lymph node dissection given the high rate of metastasis. Some studies indicate that there is no statistically significant difference in survival between SLN-positive and SLN-negative patients.…”