Treatment of Merkel Cell Carcinoma

Abstract

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.

Merkel Cell Carcinoma of the Skin: A Retrospective Study of 24 Cases by the Hellenic Cooperative Oncology Group

“…Most studies have shown the disease stage to be the most important prognostic factor for MCC [3, 4, 9,10,11,12,13]. In the study by Fenig et al [11], patients with local disease achieved longer 3-year OS compared with patients with locoregional disease (80 vs. 22%).…”

Merkel cell carcinoma of right buttock in an elderly patient: a case report

“…Nearly one-third of patients die within three years from the time of diagnosis. 12 Unfavorable prognostic factors include male gender, age more than 65 years with co-morbid diseases, distant metastatic disease, tumor of head and neck region, tumor size more than 2 cm in diameter, tumor with more than 10 mitoses per high-power field, evidence of vascular invasion, absence of an inflammatory reaction, and high expression of Kiel (Ki)-67 (proliferation index marker). 4,13 Lymph node involvement decreases survival from 88% to 50% and it shows within two years in 50% to 70% of all patients.…”

“…Surgery alone has very high local recurrence rates for this disease. 12,13 Wide surgical resection taking http://mji.ui.ac.id 3 cm margin and 2.5 cm dept is sufficient, but some authors advocate less than 2-3 cm in case of 1.5-2 cm tumor without high local recurrence. An alternative to wide local resection is Mohs micrographic surgery.…”

“…Radiotherapy plays an important role in case of large primary tumor or unattainable free surgical margin due to cosmetic or surgical difficulties and increases overall survival. 12,13,18 In case of metastatic disease, treatment option consists of palliative radiotherapy and chemotherapy. MCC is also a chemo-sensitive tumor.…”

“…5,12 Biologic agents like anti-tumor necrosis factor and imatinib mesylate promises better result on local or systemic control of MCC. 6 Radiotherapy can be used in case of cutaneous deposits or bone and brain metastasis.…”