Is Aggressive Surgical Management Justified in the Treatment of Merkel Cell Carcinoma?

Shack, R. Bruce; Barton, Ronald M.; DeLozier, Joseph B.; Rees, Roger; Lynch, John

doi:10.1097/00002341-199606000-00034

Cited by 9 publications

(12 citation statements)

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“…14,19 Prognostic factors associated with overall survival were reported in 12 series, including the present one. The most consistent of these was the stage of disease at presentation.…”

Section: Literature Reviewsupporting

confidence: 49%

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Multimodality Treatment of Merkel Cell Carcinoma: Case Series and Literature Review of 1024 Cases

et al. 2001

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“…14,19 Prognostic factors associated with overall survival were reported in 12 series, including the present one. The most consistent of these was the stage of disease at presentation.…”

Section: Literature Reviewsupporting

confidence: 49%

“…In our experience and that of others, 14,19 the outcome is dismal, with 3-year overall survival of only 31%. Because most patients die from distant metastatic disease, effective adjuvant systemic treatment is necessary to improve survival.…”

Section: Discussionmentioning

confidence: 41%

Multimodality Treatment of Merkel Cell Carcinoma: Case Series and Literature Review of 1024 Cases

et al. 2001

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“…Nevertheless, aggressive locoregional treatment, that is, wide local excision of the primary lesion with a lateral margin of at least 3 cm, combined with early elective (especially in patients with head and neck lesions) or early therapeutic lymph node dissection has been recommended by many authors. 10,[21][22][23][24] Patients with localized disease in areas where surgery could cause unacceptable cosmesis or significant functional disability and compromised quality of life create a dilemma for the clinicians and patients. For example, 1 of the patients in this study presented with a 1.5-cm Merkel cell carcinoma in the nasal ala. Should she undergo definitive radiation or surgical resection?…”

Section: Discussionmentioning

confidence: 99%

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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“…• The surgeon must not rely upon clinical appearance even in well-defined basal cell carcinomas. • Recommendations for treatment of melanoma with Breslow thickness >1.5 mm and Merkel cell carcinoma [13] cannot be deducted from the small number in the series. • There was no evidence for additional elective lymph node dissection nor oncological treatment in squamous cell carcinomas or melanomas in this series.…”

Section: Resultsmentioning

confidence: 99%

Long-term experience with ear preservation in malignant tumors of the external ear

et al. 1996

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Malignant tumors of the external ear are frequent. There is considerable discussion in the literature about the principles of surgical treatment. To find out whether ear preservation in these tumors is safe, a retrospective study was carried out in 77 consecutive patients with 91 tumors resected for suspicion of malignancy. In 70 patients the tumors were malignant. After three years, at review 62 of the 70 patients were alive, 59 (95.2%) were available for examination. Two of the 26 squamous cell carcinomas recurred, one of them in a patient with immunosuppression after kidney transplant. No metastatic disease was found. All ten patients with malignant melanoma -one of them with Breslow thickness >1.5 mm-were free of recurrence and metastasis after 49 months on average. One patient with Merkel cell carcinoma, however, died of metastatic disease to the neck, para-aortal and retropefitoneal lymph nodes. In conclusion, it is our experience that tumors of the external ear could be managed safely by conservative resection with intraoperative frozen section and meticulous long-term clinical follow-up. This allows for satisfactory preservation of the external ear.

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Is Aggressive Surgical Management Justified in the Treatment of Merkel Cell Carcinoma?

Cited by 9 publications

References 0 publications

Multimodality Treatment of Merkel Cell Carcinoma: Case Series and Literature Review of 1024 Cases

Multimodality Treatment of Merkel Cell Carcinoma: Case Series and Literature Review of 1024 Cases

Treatment of Merkel Cell Carcinoma

Long-term experience with ear preservation in malignant tumors of the external ear

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