Surgical Management of Merkel Cell Carcinoma

Allen, Peter J.; Zhang, Zuo‐Feng; Coit, Daniel G.

doi:10.1097/00000658-199901000-00013

Cited by 243 publications

(235 citation statements)

References 24 publications

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“…(continued) localized disease, with an overall 5-year survival rate of 81%. 5 In this same study, 22 of the 102 patients presented with lymph node positive disease (Stage II), with an overall 5-year survival rate of 54%.…”

Section: Discussionmentioning

confidence: 87%

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Immunohistochemical analysis of sentinel lymph nodes from patients with Merkel cell carcinoma

Allen

Busam

Hill

et al. 2001

Cancer

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Mechanical displacement of the ring by around 40 % along the approximately 9‐nm long dumbbell‐shaped component has been seen in a bistable redox‐controllable [2]rotaxane. Chemical oxidation of the tetrathiafulvalene recognition station (green, see scheme) in the dumbbell‐shaped component, which also contains a 1,5‐dioxynaphthalene recognition station (red), results in the cyclobis(paraquat‐p‐phenylene) tetracation (blue) undergoing translation from the much preferred green station to the second‐choice, red station.

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Section: Discussionmentioning

confidence: 87%

“…[5][6][7] In 1 study of 35 patients with Merkel cell carcinoma who presented with Stage I and Stage II disease, there was an overall recurrence rate of 50% . 6 Regional lymph node recurrence comprised 47% of the total failure rate and the median time to this recurrence was 5 months.…”

Section: Discussionmentioning

confidence: 99%

Immunohistochemical analysis of sentinel lymph nodes from patients with Merkel cell carcinoma

Allen

Busam

Hill

et al. 2001

Cancer

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“…The median follow-up was 16 to 18 months, but the literature suggests that the majority of lymph node recurrences appear within 1 year of diagnosis. 17,22,[45][46][47] In the largest published MCC meta-analysis, it was found that the median time to lymph node recurrence was 7 months, with 75% of these events occurring within 12 months of initial treatment. 9 Nevertheless, with longer follow-up, an increase in recurrence rates may be reported.…”

Section: Discussionmentioning

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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“…1 Approximately 20-25% of patients have regional lymph node involvement at diagnosis. 2 Local recurrence rates have been reported between 4 and 62%, 3 with the overall 5-year disease-specific survival rate being slightly over 60%. 4 The tumor typically arises in the head, neck or extremities of the elderly as a painless, rapidly growing, firm, violaceous papule or nodule.…”

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confidence: 99%

Silent mutations in KIT and PDGFRA and coexpression of receptors with SCF and PDGFA in Merkel cell carcinoma: implications for tyrosine kinase-based tumorigenesis

Kartha

Sundram

2008

Modern Pathology

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Merkel cell carcinoma is a rare and aggressive form of skin cancer of neuroendocrine origin. Its treatment involves wide excision and radiotherapy but no effective therapy exists for advanced disease. Upregulation of the platelet-derived growth factor receptor family of tyrosine kinases, PDGFRA and KIT, has a crucial role in cancer development. Several studies have shown expression of the tyrosine kinase receptor KIT (CD117) in Merkel cell carcinoma. In this study, we examined the expression and mutational status of KIT and PDGFRA in 14 primary and 18 metastatic Merkel cell carcinoma. The expression of KIT and PDGFRA and their respective ligands, stem cell factor (SCF) and PDGFA, was assessed by immunohistochemistry. In addition, we analyzed KIT exons 9, 11, 13 and 17, and PDGFRA exons 10, 12 and 18 for the presence of activating mutations. We found that only 53% of cases of Merkel cell carcinoma expressed KIT, which was mostly seen as diffuse weak staining, and SCF expression was observed only in 31% of cases. In contrast, 87 and 81% of cases expressed PDGFRA and PDGFA, respectively. We observed coexpression of SCF and KIT in only 5 of 32 cases (16%) whereas 25 of 31 cases (81%) showed coexpression of PDGFRA and its ligand PDGFA. While we documented silent mutations in exon 17 of KIT and exons 10, 12 and 18 of PDGFRA, we were not able to identify any known activating mutations. Our results indicate that there is no correlation between positive immunostaining and occurrence of activating mutations in KIT and PDGFRA. Moreover, the presence of KIT/SCF and PDGFRA/PDGFA coexpression in a proportion of cases may indicate an autocrine/paracrine stimulation loop. We think therefore that imatinib mesylate is less likely to be an effective therapy for Merkel cell carcinoma, unless activating mutations exist in other exons of these receptor kinases.

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Surgical Management of Merkel Cell Carcinoma

Cited by 243 publications

References 24 publications

Immunohistochemical analysis of sentinel lymph nodes from patients with Merkel cell carcinoma

Immunohistochemical analysis of sentinel lymph nodes from patients with Merkel cell carcinoma

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

Silent mutations in KIT and PDGFRA and coexpression of receptors with SCF and PDGFA in Merkel cell carcinoma: implications for tyrosine kinase-based tumorigenesis

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