Merkel cell carcinoma of the head and neck: poorer prognosis than non-head and neck sites

Morand, G; Madana, J.; Silva, S D Da; Hier, Michael P.; Mlynarek, Alex; Black, Martin J.

doi:10.1017/s0022215116000153

Cited by 31 publications

(23 citation statements)

References 27 publications

(34 reference statements)

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“…22 Several studies have compared the clinical outcome of head and neck (HN-) MCC with those of non-head and neck (NHN-) MCC, yielding inconsistent results. 8,13,[23][24][25][26] However, most authors state that HN-MCC has reduced overall survival (OS). In this single-center retrospective analysis, the clinical outcome of 30 NHN-MCC patients was compared with 26 HN-MCC patients.…”

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confidence: 99%

Merkel Cell Carcinoma of the Head and Neck Compared to Other Anatomical Sites in a Real-World Setting: Importance of Surgical Therapy for Facial Tumors

Kirchberger

Heppt²,

Berking³

et al. 2019

Facial Plast Surg

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Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine skin tumor with a high propensity for nodal involvement, local recurrence, and distant metastases. Up to 50% of MCC arises on head and neck (HN), which may impede oncological treatment due to insufficiently wide excisions and a lower rate of sentinel lymph node detection due to more complicated lymph drainage. Several studies have compared the clinical outcome of HN-MCC with those of non-head and neck (NHN) MCC yielding inconsistent results. This single-center, retrospective analysis compared the clinical outcome of 26 HN-MCC patients with 30 NHN-MCC patients. Overall survival (OS) and disease-free survival (DFS) were calculated with the Kaplan–Meier method assuming proportional hazards. The mean resection margins were 1.6 and 2.0 cm for the HN and NHN cohort, respectively. Local relapses were more frequently observed in patients with HN-MCC (19 vs. 10%). Patients with HN-MCC had a median OS of 4.3 years compared with 7.5 years in patients with NHN-MCC (p = 0.277). The median OS by tumor stage was 11, 3, 2, and 3 years in stage I, II, III, and IV disease, respectively (p = 0.009). The median DFS in HN-MCC was 10 years and not reached in the cohort with NHN-MCC patients (p = 0.939). Our data suggest a trend toward poorer outcomes of HN-MCC compared with NHN-MCC. Patients with MCC on the head and neck carry a higher risk for local relapse, requiring resolute surgical treatment also in facial localizations at early stages.

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Merkel Cell Carcinoma of the Head and Neck Compared to Other Anatomical Sites in a Real-World Setting: Importance of Surgical Therapy for Facial Tumors

Kirchberger

Heppt²,

Berking³

et al. 2019

Facial Plast Surg

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“…In addition, the complex lymphatic drainage patterns in the HN could increase the risk of local/regional relapses after surgery alone 5, 34, 35, 36. Given these concerns, we hypothesized that even patients with low-risk Stage IA HN MCC may be at a greater risk of developing an LR if they are treated with surgery alone.…”

Section: Discussionmentioning

confidence: 99%

Postoperative radiation therapy is associated with a reduced risk of local recurrence among low risk Merkel cell carcinomas of the head and neck

Takagishi

Marx

Lewis

et al. 2016

Advances in Radiation Oncology

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PurposeMerkel cell carcinoma (MCC) is a rare and often aggressive skin cancer. Typically, surgery is the primary treatment. Postoperative radiation therapy (PORT) is often recommended to improve local control. It is unclear whether PORT is indicated in patients with favorable Stage IA head and neck (HN) MCC.Methods and materialsWe conducted a retrospective analysis of 46 low-risk HN MCC cases treated between 2006 and 2015. Inclusion criteria were defined as a primary tumor size of ≤ 2 cm, negative pathological margins, negative sentinel lymph node biopsy, and no immunosuppression. Local recurrence (LR) was defined as tumor recurrence within 2 cm of the primary surgical bed and estimated with the Kaplan-Meier method.ResultsOmission of PORT was offered to all 46 patients, of which 23 patients received PORT and 23 did not. No patient received adjuvant chemotherapy. There were no significant differences in surgical margins, tumor size, depth, lympho-vascular invasion status, or demographics between the two patient groups. Median follow-up for all patients was 3.7 years. Six of the 23 patients who did not receive PORT developed an LR. Compared to the group that received PORT, there was a significantly higher risk of LR in the group treated without PORT (26% vs. 0%, P = .02). Median time to LR was 11 months. All local failures were effectively salvaged. There was no difference in MCC-specific and overall survival between the 2 groups.ConclusionsFor patients with HN MCC, omission of PORT was associated with a significantly higher risk of local recurrence even among those patients with the lowest-risk tumors (i.e., Stage IA without immune suppression). Thus, it is important to weigh the benefits of PORT against the side effect profile on a case-specific basis for each patient.

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“…1 Surgem frequentemente em áreas fotoexpostas, traduzindo o papel contributivo do dano solar, em particular pela radiação ultravioleta B ao induzir atividade aberrante do p53. 4,10 É um tumor que ocorre essencialmente acima dos 50 anos, com o dobro da incidência no sexo masculino. 40 O estadiamento TNM do carcinoma de Merkel foi formulado em 2010 pela AJCC, e é diferente dos restantes cancros cutâneos.…”

Section: Carcinoma De Células De Merkelunclassified

“…3 A gestão terapêutica dos tumores cutâneos de cabeça e pescoço é delicada, sobretudo na gestão das margens cirúrgicas, pelas implicações na anatomia e função desta área esteticamente sensível. 4 Também a questão da metastização linfática regional é de complexa abordagem diagnóstica e cirúrgica devido a um padrão de drenagem linfática variável, arborização complexa e proximidade de estruturas vitais (como por exemplo via aérea, artéria carótida, veia jugular, canal torácico, nervos pneumogástri-co, frénico, espinhal e nervo facial). 5,6 …”

Section: Introductionunclassified

“…4 Também a questão da metastização linfática regional é de complexa abordagem diagnóstica e cirúrgica devido a um padrão de drenagem linfática variável, arborização complexa e proximidade de estruturas vitais (como por exemplo via aérea, artéria carótida, veia jugular, canal torácico, nervos pneumogástri-co, frénico, espinhal e nervo facial). 5,6 CONTEXTUALIZAÇÃO HISTÓRICA A abordagem atual da metastização linfática regional cervical dos tumores cutâneos é o resultado do entrecruzamento da evidência publicada nas áreas de oncologia dermatológica e cirurgia oncológica cervical.…”

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A Metastização Cervical dos Cancros Cutâneos de Cabeça e Pescoço

Oliveira

Cabete

Semedo

et al. 2017

SPDV

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RESUMO -O cancro cutâneo é a neoplasia mais frequente de todas, com maior incidência na área de cabeça e pescoço, pela fotoexposição crónica. A estratificação do risco metastático linfático regional cervical tende a ser sistematizada de acordo com modelos de estadiamento tumoral, que são tendencialmente aceites no melanoma e carcinoma de células de Merkel, mas pouco consensuais no carcinoma espinocelular. Um dos focos de investigação é o risco de micrometástases em casos de tumores de estádio clínico e imagiológico N0, de que um modo geral varia entre 5% a 20% nos carcinomas espinocelulares, cerca de 20% nos melanomas e de 20 a 50% nos carcinomas de células de Merkel, dependendo de vários fatores de risco. A utilidade do gânglio sentinela e os protocolos de acompanhamento são também matéria de discussão. PALAVRAS-CHAVE - INTRODUÇÃOO cancro cutâneo é a neoplasia mais frequente no ser humano, com uma incidência de cerca de 2 milhões de casos/ano nos Estados Unidos. 1,2 A cabeça e pescoço, por ser uma área exposta a radiação solar, é também a de maior risco e maior frequência dos tumores cutâneos, contando com cerca de 80% dos casos. 2 Em Portugal não é possível uma comparação direta, já que o registo oncológico regional apenas contabiliza o melanoma maligno da pele. 3 A gestão terapêutica dos tumores cutâneos de cabeça e pescoço é delicada, sobretudo na gestão das margens cirúrgicas, pelas implicações na anatomia e função desta área esteticamente sensível. 4 Também a questão da metastização linfática regional é de complexa abordagem diagnóstica e cirúrgica devido a um padrão de drenagem linfática variável, arborização complexa e proximidade de estruturas vitais (como por exemplo via aérea, artéria carótida, veia jugular, canal torácico, nervos pneumogástri-co, frénico, espinhal e nervo facial). 5,6

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Merkel cell carcinoma of the head and neck: poorer prognosis than non-head and neck sites

Cited by 31 publications

References 27 publications

Merkel Cell Carcinoma of the Head and Neck Compared to Other Anatomical Sites in a Real-World Setting: Importance of Surgical Therapy for Facial Tumors

Merkel Cell Carcinoma of the Head and Neck Compared to Other Anatomical Sites in a Real-World Setting: Importance of Surgical Therapy for Facial Tumors

Postoperative radiation therapy is associated with a reduced risk of local recurrence among low risk Merkel cell carcinomas of the head and neck

A Metastização Cervical dos Cancros Cutâneos de Cabeça e Pescoço

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