The Surgical Management of Primary and Metastatic Merkel Cell Carcinoma

Gonzalez, Ricardo J.; Padhya, Tapan; Cherpelis, Basil S.; Prince, Melanie D.; Aya-ay, Melanie L.; Sondak, Vernon K.; Cruse, C. Wayne; Zager, Jonathan S.

doi:10.1016/j.currproblcancer.2010.02.003

Cited by 25 publications

(31 citation statements)

References 57 publications

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“…With that being said, it is well known that MCC is radiosensitive and that adjunctive radiotherapy, provided to decrease locoregional recurrence in patients with bulky nodal disease or extracapsular extension, as definitive therapy for those patients medically unable to undergo surgical resection, or as definitive therapy in those with sentinel node-positive disease, are also a viable treatment alternatives to LND. 25–28 Three patients in this series (8%) with MCCUP received definitive radiotherapy alone. Interestingly, these patients were older (median age 82 years) and had larger tumors (median 5.0 cm) than the other treatment groups.…”

Section: Discussionmentioning

confidence: 94%

Merkel Cell Carcinoma of Unknown Primary Origin

et al. 2012

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Background Merkel cell carcinoma (MCC) is a rare neuroendocrine tumor of the skin. MCC from an unknown primary origin (MCCUP) can present a diagnostic and therapeutic challenge. We describe our single-institution experience with the diagnosis and management of MCCUP presenting as metastases to lymph nodes. Methods After institutional review board approval, our institutional database spanning the years 1998–2010 was queried for patients with MCCUP. Clinicopathologic variables and outcomes were assessed. Results From a database of 321 patients with MCC, 38 (12%) were identified as having nodal MCCUP. Median age was 67 years, and 79% were men. Nodal basins involved at presentation were cervical (58%), axillary/epitrochlear (21%), or inguinal/iliac (21%). CK20 staining was positive in 93% of tumors tested, and all were negative for thyroid transcription factor-1. Twenty-nine patients (76%) underwent complete regional lymph node dissection (LND): 3 had LND alone, ten had LND and adjuvant radiotherapy, and 16 underwent LND followed by chemoradiotherapy. Definitive chemoradiotherapy without surgery was provided to six patients (16%), while radiotherapy alone was provided to three (8%). Recurrence was observed in 34% of patients. Median recurrence-free survival was 35 months. Ten patients (26%) died, five of disease and five of other causes. The median overall survival was 104 months. Conclusions Nodal MCCUP is a rare disease affecting primarily elderly white men. Recurrence is observed in approximately one-third of patients, with a 104 month median overall survival after a multimodal treatment approach consisting of surgery along with adjuvant chemotherapy and radiotherapy in the majority of patients.

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Section: Discussionmentioning

confidence: 94%

Merkel Cell Carcinoma of Unknown Primary Origin

et al. 2012

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“…pain/bleeding/intestinal obstruction if morbidity can be minimised. It can be considered in those re-presenting with recurrent oligometastatic disease who have experienced a lengthy disease-free interval, although these cases are rare [6,28].…”

Section: Surgerymentioning

confidence: 96%

“…Removal by wide local excision is typical, with some also offering newer techniques, e.g. Moh's micrographic surgery, to ensure adequate clear margins at excision [28]. Wide local excision with a margin of 1e2 cm has generally been accepted as standard, with some recommending up to 3 cm, although there are no randomised trials evaluating margins.…”

Section: Primary Tumourmentioning

confidence: 98%

Merkel Cell Carcinoma: Current Management and Controversies

Prewett¹,

Ajithkumar²

2015

Clinical Oncology

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“…Currently, the generally accepted approach to patients with clinically negative nodal basins is surgical resection of the primary tumor with appropriate margins, as well as SLNB [17,[20][21][22]. SLNB positivity rates of 11-47% in patients with MCC have been reported in the literature [20]. Understandably, identification of groups most and least likely to benefit from this procedure is desirable.…”

Section: Role Of Sentinel Lymph Node Biopsy In MCCmentioning

confidence: 98%

“…This concept has led to the recommendation that sentinel lymph node biopsy (SLNB) be used in the initial surgical treatment and staging of MCC [20,21]. Currently, the generally accepted approach to patients with clinically negative nodal basins is surgical resection of the primary tumor with appropriate margins, as well as SLNB [17,[20][21][22].…”

Section: Role Of Sentinel Lymph Node Biopsy In MCCmentioning

confidence: 99%