Local control of primary Merkel cell carcinoma: Review of 45 cases treated with Mohs micrographic surgery with and without adjuvant radiation

Boyer, Julien; Zitelli, John A.; Brodland, David G.; D’Angelo, Gina

doi:10.1067/mjd.2002.125083

Cited by 210 publications

(147 citation statements)

References 26 publications

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“…4 MCC is a rare disease, and therefore to the best of our knowledge no randomized controlled trials to define optimal treatment have been performed to date. Numerous retrospective studies have been performed assessing the role of radiation treatment [5][6][7][8][9][10][11][12][13] with the growing consensus that radiotherapy confers local and regional control improvements. A recent population-based study suggested a survival benefit with adjuvant radiotherapy.…”

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confidence: 99%

Radiation monotherapy as regional treatment for lymph node‐positive Merkel cell carcinoma

Fang

Lemos

Douglas

et al. 2010

Cancer

145

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BACKGROUND:Merkel cell carcinoma (MCC) is an aggressive cutaneous malignancy with a high risk of lymph node involvement. To the authors' knowledge, few data have been published to date regarding the optimal regional therapy for lymph node‐positive patients. This cohort study was performed to analyze the outcomes of patients with lymph node‐positive MCC treated with lymph node irradiation as definitive therapy compared with completion lymphadenectomy (CLND).METHODS:Fifty patients with lymph node involvement of MCC at presentation and adequate follow‐up data were included in this analysis. Forty‐three of these patients were enrolled and followed prospectively. Twenty‐six patients presented with microscopic lymph node disease, and 24 patients presented with palpable lymph node involvement.RESULTS:Regional control for patients with microscopically involved lymph nodes was 100% regardless of treatment modality—definitive lymph node irradiation (n = 19) or CLND ± radiotherapy (n = 7) with median follow‐up of 18 months. Patients with clinically positive lymph nodes had 2‐year regional recurrence‐free survival rate of 78% and 73% in the definitive lymph node irradiation (n = 9) and CLND ± radiotherapy (n = 15) groups, respectively (P = .8) with a median follow‐up of 16 months.CONCLUSIONS:To the best of the authors' knowledge, the current study is the largest series published to date of radiation monotherapy as regional treatment for lymph node‐positive MCC. Lymph node irradiation alone to positive regional lymph nodes was found to confer an excellent regional control rate that was comparable to CLND for both microscopic and palpable lymph node disease. There was no difference noted with regard to overall survival. Given their similar efficacy, the choice between these lymph node therapies may be based on the clinical scenario and anticipated side effect profiles. Cancer 2010. © 2010 American Cancer Society.

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confidence: 99%

Radiation monotherapy as regional treatment for lymph node‐positive Merkel cell carcinoma

Fang

Lemos

Douglas

et al. 2010

Cancer

145

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“…There are insufficient studies to support the use of chemotherapy to improve survival in metastatic MCC [27]. One of the most commonly used chemotherapy regimens are cyclophosphamide/doxorubicin with an overall complete response rate of 30-40% [28]. Patients with distant disease have a median survival of nine months.…”

Section: Chemotherapymentioning

confidence: 99%

“…Current data does not show prolonged survival for adjuvant chemotherapy [26]. There are insufficient studies to support the use of chemotherapy to improve survival in metastatic MCC [27]. One of the most commonly used chemotherapy regimens are cyclophosphamide/doxorubicin with an overall complete response rate of 30-40% [28].…”

Section: Chemotherapymentioning

confidence: 99%

Surgical Management of Head and Neck Merkel Cell Carcinoma, are we doing Enough?

O’Duffy¹,

O’Dwyer²,

Gendy³

2014

Otolaryngology

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“…Moreover, it is important to be aware that MCC has a high rate of recurrence with a reported 4% and 6% incidence of recurrence locally and regionally, respectively, and a worrisome 8% incidence of recurrent distant metastasis. 7 Taking this into consideration, the NCCN recommends a thorough physical exam including a regional lymph node exam every 3 to 6 months for 2 years, followed by every 6 to 12 months thereafter. In our case, multidisciplinary teamwork allowed treatment with a combination of surgical excision and adjuvant radiation leading to disease-free survival at 2.5-year follow-up.…”

mentioning

confidence: 99%

“…A 45-to 60-Gy dose has been shown to be beneficial. 7 Multiple factors must be considered when closing a tumor defect after wide local incision. In this case, considerations included age, comorbidities, medical history, and need for radiation therapy.…”

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confidence: 99%

Merkel Cell Carcinoma of the Hand

Westerveld

Hall

Richards

2016

Hand (New York, N,Y.)

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Background: Merkel cell carcinoma (MCC) is a relatively rare and aggressive cutaneous neuroendocrine malignancy characterized by high incidence of local recurrence, distant metastases, regional nodal metastases, and high mortality. Clinically, MCC presents as a persistent asymptomatic red/pink shaped nodule, usually smaller than 2 cm with nontender intracutaneous swelling, with rapidly growing localized disease with lymph node metastases preceding distant metastases. Because of its rare nature and the lack of comprehensive understanding of the disease, management of MCC has been controversial. Methods: An 87-year-old retired Caucasian male with a history of tobacco use, chronic sun exposure, and multiple squamous and basal cell carcinomas presented with a 1.8 × 1.3 cm red, nontender nodule on the dorsum of the proximal phalanx of the left long finger first noticed 6 months prior to presentation. Biopsy was consistent with MCC after which he was treated with wide local excision, full-thickness skin grafting, and sentinel lymphadenectomy (1/4 nodes positive) followed by adjuvant radiation therapy. Results: He recovered appropriately and was clinically and radiographically disease free at 2.5-year follow-up. Conclusion: Although it remains rare, MCC has increased in incidence over the last several decades and has a predilection to occur over sun exposed areas. Highly aggressive, it has a high incidence of regional and distant metastasis as well as local recurrence. As a result, it is important that practitioners involved in the care of skin and hand lesions be aware of this condition and the need for a multidisciplinary treatment approach.

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Local control of primary Merkel cell carcinoma: Review of 45 cases treated with Mohs micrographic surgery with and without adjuvant radiation

Cited by 210 publications

References 26 publications

Radiation monotherapy as regional treatment for lymph node‐positive Merkel cell carcinoma

Radiation monotherapy as regional treatment for lymph node‐positive Merkel cell carcinoma

Surgical Management of Head and Neck Merkel Cell Carcinoma, are we doing Enough?

Merkel Cell Carcinoma of the Hand

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