Merkel Cell Carcinoma of the Head and Neck: A Single Institutional Experience

Abstract

Merkel cell carcinoma (MCC) is a rare cutaneous malignancy occurring mostly in older immunocompromized Caucasian males. A growing incidence of MCC has been reported in epidemiological studies. Treatment of MCC usually consists of surgical excision, pathological lymph node evaluation, and adjuvant radiotherapy. This paper reports the experience of a single tertiary center institution with 17 head and neck Merkel cell carcinoma patients. Median followup for the cohort was 37.5 months. After five years, recurrence-free survival, disease specific survival, and overall survival were 85%, 90%, and 83%, respectively. Our limited data support the use of adjuvant radiotherapy. We also report two cases of MCC located at the vestibule of the nose and two cases of spontaneous regression after diagnostic biopsy. About 40% of our patients were referred to our center for surgical revision and pathological lymph node evaluation. Increased awareness of MCC and an interdisciplinary approach are essential in the management of MCC.

Sentinel lymph node biopsy in Merkel cell carcinoma: a 15-year institutional experience and statistical analysis of 721 reported cases

“…Twenty‐seven studies encompassing 242 patients provided case‐level information regarding regional radiotherapy. Administration of adjuvant radiotherapy to a negative SLNB site did not significantly affect regional recurrence (14·3% with radiotherapy vs. 4·6% without radiotherapy, P = 0·31) …”

“…The remaining 68 publications were retrieved and appraised in full along with an additional 50 articles identified through bibliography review and other sources. Following full‐text review, 36 case series encompassing 692 patients fulfilled the inclusion criteria of our study . These included one French and one Italian publication.…”

“…With the addition of our own cohort, the cumulative review comprised 37 reports from 1997 to 2015 documenting 721 cases (Table ). Thirty‐three studies containing 646 patients reported the site of the primary MCC, which was located on the head and neck (35·5%), limbs (51·1%) or trunk (13·4%) . Twenty‐six series comprising 272 patients reported a mean of 1·9 ± 1·1 lymph nodes removed during the SLNB procedure .…”

“…Twenty‐seven studies containing 257 patients provided individual patient data regarding the site of the primary MCC, SLN status and regional relapse . The rate of false negative SLNBs among head and neck (6·7%) and nonhead and neck (5·4%) MCCs was not significantly different ( P = 0·58).…”

Merkel cell carcinoma: Do you know your guidelines?

“…Surgery continues to be the recommended primary modality of treatment with wide local excision with negative margins when possible, and selective neck dissection when indicated. There is some controversy regarding margin width and investigations have demonstrated no difference in recurrence‐free survival based on the size of the surgical margin . Therefore, the current NCCN guidelines recommend a 1 to 2‐cm margin when feasible, however, they note that negative margin resection should NOT be pursued to the degree of significantly delaying adjuvant radiotherapy because of data that indicates that margin status may not have significant impact in high‐risk MCC receiving radiation .…”