Merkel Cell Tumor of the Head and Neck Five New Cases With Literature Review

Rice, Reginald D.; Chonkich, George D.; Thompson, Kevin; Chase, Donald R.

doi:10.1001/archotol.1993.01880190078016

Cited by 34 publications

(19 citation statements)

References 25 publications

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“…A more recent review of 321 patients with head and neck Merkel cell carcinoma, plus the authors' 5 cases, showed that the cheek and eyelids are the most common sites, totaling 47%. 4 Detailed analysis of 89 cases by these authors showed 45 men and 44 women, average age 72.1 years, average size 2 cm, 11% nodal metastasis at presentation, 37% local recurrence, 48% regional metastasis, 21% both local recurrence and regional metastasis, and 28% distant metastasis. Table 2 compares the patterns of relapse and survival rates from several studies.…”

Section: Discussionmentioning

confidence: 97%

“…Since Toker's first description of 5 cases of "trabecular carcinoma of the skin" in 1972 1 and Tang and Toker's postulation of Merkel cell as the cell of origin in 1978, 2 the total number of cases reported in the literature is estimated to be approximately 400 to 1000 cases. [3][4][5][6][7] The optimum method of diagnosis and treatment of Merkel cell carcinoma remain obscured. Like with other uncommon diseases, optimal treatment is based on experience gained from the study of retrospective cases.…”

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confidence: 99%

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Treatment of Merkel Cell Carcinoma

Eng¹,

Boersma²,

Fuller³

et al. 2004

American Journal of Clinical Oncology

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Purpose: The purpose of this study was to evaluate the treatment of Merkel cell carcinoma. Materials and Methods: We reviewed 85 cases of Merkel cell carcinoma. There were 68 males and 17 females. The majority of cases involved head and neck sites (48%), followed by the extremities (38%) and trunk (14%). Sixty-seven percent of the patients had stage I disease that was localized to the skin of origin at presentation. Twenty-five percent and 8% were stage II (nodal metastasis) and stage III (distant metastasis), respectively. Surgical intervention included local or wide local excision Ϯ nodal dissection (68%), radical resection Ϯ nodal dissection (22%), and amputation (4%). Five patients (6%) underwent biopsy only because of metastatic disease or unresectability at presentation. Fifty-one percent received adjuvant therapy consisting of external beam radiation therapy and/or combination chemotherapy. Results: With an average follow-up time of 39.5 months, 12% had persistent disease and 40% had recurrent disease. The median time to recurrence was 8 months with a mean of 10.6 months. Although the addition of adjuvant therapy did not affect survival, the recurrence rate was 32.5% for surgery Ϯ adjuvant radiation therapy Ϯ chemotherapy as compared with 52.7% for surgery-only patients. Although the 40.7% recurrence rate for patients receiving surgery and adjuvant radiation therapy was approximately the same as for patients receiving surgery and adjuvant chemotherapy (40%), the effect of systemic chemotherapy on recurrence is less clear as a result of the small number of patients who received such therapy. Although tumor size and site of presentation were not observed to be statistically significant in overall survival, significant differences were observed based on sex and tumor stage. For females, the median survival time was 96 months (mean, 94.5 months) compared with 63 months (mean, 76.8 months) for males. This difference was significant (P Ͻ 0.01). Patients presenting with low-stage (stage I) disease had a significant (P Ͻ 0.01) survival benefit when compared with high-stage individuals (stages II and III). The 5-year actuarial survival rates were 68% and 42%, respectively. Conclusion:In this retrospective study, surgery remains the primary modality for Merkel cell carcinoma, and adjuvant radiation therapy Ϯ systemic chemotherapy reduces local recurrence. Female patients and those who present with early-stage disease appear to have a better prognosis.

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Section: Discussionmentioning

confidence: 97%

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confidence: 99%

Treatment of Merkel Cell Carcinoma

Eng¹,

Boersma²,

Fuller³

et al. 2004

American Journal of Clinical Oncology

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“…5,7,18,20,22 Chemotherapy has, intuitively, been the most frequently used treatment of recurrent metastatic disease, but treatment gains have proved ephemeral. 33,34 Although there are no clinical recommendations regarding treatment of recurrence, most authors agree that treatment should not err on the side of passivity.…”

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confidence: 99%

Treatment of Recurrent Merkel Cell Carcinoma: An Analysis of 46 Cases

Eng

Naguib

Fuller

et al. 2004

American Journal of Clinical Oncology

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This report describes the course of recurrent Merkel cell carcinoma and defines possible treatment strategies for recurrent disease as seen in a long-term multisite retrospective analysis. Merkel cell carcinoma is a highly aggressive neuroendocrine skin cancer. Surgery and radiation therapy have been demonstrated ability to control this disease; however, recurrence is common. Systemic chemotherapy has, as yet, no presently defined role in primary treatment, and few conclusions can be reached regarding optimal treatment of disease recurrence. Forty-six patients were identified over the last 15 years in a retrospective analysis of patient records from several hospitals in the San Antonio, TX area. Hospital charts as well as outpatient treatment records were reviewed. Almost all patients developing recurrent disease did so within the first 2 years after primary treatment. Patients presenting distant disease had a median survival of 12 months, faring worse than those who display local or nodal disease. For patients with nodal or local recurrence, the mean survival after combination therapy (chemotherapy, radiation +/- surgery) was 36.5 months as compared with 17.5 months for those treated with a single modality (surgery or radiation or chemotherapy). The overall survival rate for the 46 patients with recurrence was 37%. Multimodality therapy has shown the best results for recurrent Merkel cell carcinoma thus far, and should be used if tolerated by the patient. Aggressive salvage surgery for local or nodal recurrence is encouraged, because this disease has a tendency to become more destructive upon recurrence. Adjuvant radiation therapy should also be used, if the patient has not exceeded their dose limitations. Disseminated disease, whether primary or recurrent, warrants further investigation in terms of optimal treatment.

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“…Common characteristics. Six studies were identified which reported 23 patients with LN metastatic MCC in the absence of a primary site (12)(13)(14)(15)(16)(17). Of these patients, 8/23 (34.8%) came from Italy and the rest from the USA.…”

Section: A B C D Ementioning

confidence: 99%

Merkel cell carcinoma with lymph node metastasis in the absence of a primary site: Case report and literature review

Zhao

Meng

2012

Oncology Letters

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Abstract. Merkel cell carcinoma (MCC) is a rare malignant skin neoplasm with the potential for local recurrence, spreading to regional lymph nodes (LNs) and distant metastases. Although it has been identified in various anatomical sites, LN metastatic MCC in the absence of a primary site is extremely rare. The present case reports a 54-year-old male who initially underwent histological examination of a biopsy specimen from the right inguinal LNs. A diagnosis of metastatic small cell carcinoma was made. Nine months later, this diagnosis was changed to MCC with multiple metastases following observation of a tumour mass in the right dorsal thigh. Additionally, in the present study a summary is provided of 23 published cases of MCC with initial LN metastasis in the absence of a primary site, with details of clinical characteristics, natural history and pertinent therapy of this uncommon tumour. The present patient with LN metastatic MCC in the absence of a primary site and the other reported cases demonstrate that although multimodal treatment with surgery, radiotherapy (RT) and chemotherapy provides excellent local control, local recurrence and distant metastases commonly develop in this uncommon tumour. LN metastatic MCC in the absence of a primary site is a highly malignant disease and the role of adjuvant postoperative RT and/or chemotherapy remains to be fully determined.

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Merkel Cell Tumor of the Head and Neck Five New Cases With Literature Review

Cited by 34 publications

References 25 publications

Treatment of Merkel Cell Carcinoma

Treatment of Merkel Cell Carcinoma

Treatment of Recurrent Merkel Cell Carcinoma: An Analysis of 46 Cases

Merkel cell carcinoma with lymph node metastasis in the absence of a primary site: Case report and literature review

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