A Practical Update of Surgical Management of Merkel Cell Carcinoma of the Skin

Abstract

The role of surgeons in the treatment of Merkel cell carcinoma (MCC) of the skin is reviewed, with respect to diagnosis and treatment. Most of the data in the literature are case reports. Surgery is the mainstay of treatment. A wide local excision, with sentinel node (SLN) biopsy, is the recommended treatment of choice. If SLN is involved, nodal dissection should be performed; unless patient is unfit, then regional radiotherapy can be given. Surgeons should always refer patients for assessment of the need for adjuvant treatments. Adjuvant radiotherapy is well tolerated and effective to minimize recurrence. Adjuvant chemotherapy may be considered for selected node-positive patients, as per National Comprehensive Cancer Network guideline. Data are insufficient to assess whether adjuvant chemotherapy improves survival. Recurrent disease should be treated by complete surgical resection if possible, followed by radiotherapy and possibly chemotherapy. Generally results of multimodality treatment for recurrent disease are better than lesser treatments. Future research should focus on newer chemotherapy and molecular targeted agents in the adjuvant setting and for gross disease.

Merkel Cell Carcinoma: Current Management and Controversies

“…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. Moh's surgery may enable a greater certainty of achieving clear margins, particularly at depth and may be valuable in sites where cosmesis is important [29].…”

Merkel Cell Carcinoma Masquerading As Cellulitis: A Case Report and Review of the Literature

“…Though mcc accounts for less than 1% of cutaneous malignancies, the incidence is rising 3 . Analysis of 1,124 identified cases of mcc in the Surveillance, Epidemiology, and End Results (seer) database demonstrated an increased incidence over a 15-year period (from 0.15 cases per 100,000 in 1986 to 0.44 case per 100,000 in 2001) 5 . In the United States, the estimated annual incidence of mcc is 0.23 per 100,000 in Caucasian individuals.…”

“…Surgical resection is the mainstay treatment for localized disease (N0 and M0). Tai recommends Mohs micrographic surgery along with wide local excision with negative margins of 1 to 2 cm for good disease-free survival 5 . The use of radiation therapy following surgical treatment remains controversial given the lack of adequate evidence to support or contradict its use.…”

Merkel cell carcinoma: literature review

“…Current optimal treatment is with radical surgical excision of the primary tumour, sentinel lymph node biopsy, ± regional lymph node dissection, radiotherapy, chemotherapy & immunotherapy [10,39,40].…”