Shared decision-making in treatment of Merkel cell carcinoma

Abstract

SUMMARYAn 82-year-old woman presented with an asymptomatic mass, rapidly growing on her left cheek for the previous 3 months. Punch biopsy of the tumour was performed, and the pathology was compatible with Merkel cell carcinoma. A resection margin of more than 1 cm would involve left oral commissura, potentially damaging speech, eating and drinking ability. The patient had a strong wish of keeping surgery simple in order to maintain quality of life. Tumour excision was performed with 1 cm resection margin, and postoperatively the patient was referred to adjuvant radiation therapy. Sensibility of upper and lower lip remained unaffected, while motor innervation of left upper lip was impaired. Despite this, the patient's ability to talk and eat was unaffected. Surgery, with adjunctive radiation therapy, is the first-line of treatment for the primary tumour. The option for a more conservative treatment is not first choice, but can be considered upon individual assessment. BACKGROUND

Unknown primary Merkel cell carcinoma with cutaneous spread

“…As MCC is such a rare and a challenging disease, treatment approaches should always be discussed in a multidisciplinary team and considered individually, in light the existing evidence combined with a reference centre expertise. The case reported by Muus Steffensen S et al is a good example of a patient with MCC treated with multimodal approaches (in this case, conservative surgery and adjuvant RT) allowing a combination of patient’s preferences, available treatments and evidence 1…”