Management of Merkel Cell Carcinoma: The Roles of Lymphoscintigraphy, Sentinel Lymph Node Biopsy and Adjuvant Radiotherapy

Warner, Ross; Quinn, Michael J.; Hruby, George; Scolyer, Richard A.; Uren, Roger F.; Thompson, John F.

doi:10.1245/s10434-008-9983-1

Cited by 96 publications

(102 citation statements)

References 63 publications

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“…Unfortunately due to the low incidence rate of PCAC, SLNB has not undergone prospective evaluation, but has been shown to provide prognostic value among other cutaneous neoplasms, including melanoma [17], squamous cell carcinoma [18] and merkel cell carcinoma [19]. Although this may suggest SLNB to be useful in this population, treatment should be determined on a case by case basis, as lymph node dissection is not standard practice for PCAC [16].…”

Section: Discussionmentioning

confidence: 99%

Treatment of primary cutaneous apocrine carcinoma of the scalp - case and review of the literature

Brown¹,

Riesco-Martinez²,

Petrella³

2016

Glob Dermatol

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A previously healthy 42 year-old woman presented at her family doctor after her hairdresser noticed a nodule in the left temporo-parietal area of the scalp. The mass was a firm, reddish nodule measuring approximately 3 × 2 cm. The patient was completely asymptomatic. She was referred to dermatology, and the lesion was excised. The initial pathology report showed a moderately-well differentiated adenocarcinoma. It was unclear at this time whether this was a primary lesion of the sweat gland or metastatic adenocarcinoma from another site. She was then referred to our centre for oncologic work-up.The pathology was reviewed and confirmed a moderately differentiated adenocarcinoma (Figure 1). The tumour was formed by single tubules or complex back to back tubular structures with areas where the luminal cells showed apical snouts. The lesion filled the reticular dermis without involving the epidermis. No perineural or lymphovascular invasion was present. The resection margins were clear, with the closest margin at 2 mm. The immunohistochemistry showed positivity for CK 7, ER, PR, Androgen receptor, CDX2, Ber ep4 and EMA. It was found to be negative for High molecular weight keratin, CK 20, COX2, CDX2, TTF1, Renal cell marker, CD 117, and CEA. It was concluded that this profile was most consistent with a metastatic breast carcinoma; however an eccrine/apocrine carcinoma of the skin could not be completely ruled out.On physical examination, there was no palpable lymphadenopathy of the neck, supraclavicular or infraclavicular regions bilaterally. No pre-or postauricular lymphadenopathy. On the left temporal parietal scalp, there was a 3 cm, well-healed scar, with no signs of infection or IntroductionPrimary cutaneous apocrine carcinoma (PCAC) is a rare type of sweat gland neoplasm with incidence rates estimated to range from 0.0049-0.0173 per 100,000 patients per year [1]. Approximately 200 total cases are reported in the literature. PCAC occurs in areas with large numbers of apocrine glands [2]. The scalp is among one of the rarest sites of occurrence, while the axilla appears most commonly [3]. Among the 186 cases reviewed by Hollowell, equal distribution was present in both males and females, with 76% of the sample population of Caucasian ethnicity. Median age was calculated at 67 years for this sample, which is the largest cohort studied to date [1].PCAC can develop in the dermal and subcutaneous layers of the skin, occasionally infiltrating the epidermal layer resulting in ulceration. PCAC has a diverse presentation, occurring as both uniand multi-nodular growths with varying colour [2]. Often these neoplasms are indurated, painless masses and can be associated with benign lesions [2], including a nevus sebaceous, most commonly seen with scalp lesions [4][5][6]. Development of these lesions typically occurs within a year before diagnosis [7]; however several cases have reported longer durations with a period of rapid growth [4,5,8,9]. PCAC is often quite difficult to differentiate from metastases of adenocarcinoma o...

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Section: Discussionmentioning

confidence: 99%

Treatment of primary cutaneous apocrine carcinoma of the scalp - case and review of the literature

Brown¹,

Riesco-Martinez²,

Petrella³

2016

Glob Dermatol

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“…43,44 Thus lymphoscintigraphy performed as part of the SLNB technique may be used to define the draining lymph nodes and assist in the planning of radiotherapy. This has been illustrated by a study by Warner et al, 41 in which 6 patients underwent lymphoscintigraphy without proceeding to resection of the sentinel nodes. Three of these patients received radiotherapy to the nodal basin in which the sentinel node had been localized, and none developed nodal relapse.…”

Section: J Am Acad Dermatolmentioning

confidence: 99%

Merkel cell carcinoma: An Australian perspective and the importance of addressing the regional lymph nodes in clinically node-negative patients

Howle

Hughes

Gebski

et al. 2012

Journal of the American Academy of Dermatology

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“…The other 2 patients with negative sentinel nodes received postoperative radiation, and 1 developed an in-transit recurrence but neither failed in the nodal basin. 47 These results suggest a much higher rate of false-negative sentinel node biopsies than has been reported in other series with MCC or in melanoma. 46,48 This experience is contrasted with the meta-analysis by Mehrany and coworkers, in which 39 of 40 patients with a negative sentinel node biopsy, with relatively short follow-up (median of 7.3 months), did not recur, despite the fact that 35 of the 40 patients did not receive additional treatment (either surgical or radiation) to their regional nodal basin.…”

Section: Negative Sentinel Lymph Node Biopsymentioning

confidence: 49%

The Surgical Management of Primary and Metastatic Merkel Cell Carcinoma

Gonzalez

Padhya

Cherpelis

et al. 2010

Current Problems in Cancer

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Management of Merkel Cell Carcinoma: The Roles of Lymphoscintigraphy, Sentinel Lymph Node Biopsy and Adjuvant Radiotherapy

Abstract: The results suggest that SN status may not be an accurate predictor of loco-regional recurrence in MCC. However, they strongly reinforce previous reports that radiotherapy, both locally and to regional nodes, provides effective infield disease control.

Cited by 96 publications

References 63 publications

Treatment of primary cutaneous apocrine carcinoma of the scalp - case and review of the literature

Treatment of primary cutaneous apocrine carcinoma of the scalp - case and review of the literature

Merkel cell carcinoma: An Australian perspective and the importance of addressing the regional lymph nodes in clinically node-negative patients

The Surgical Management of Primary and Metastatic Merkel Cell Carcinoma

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