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Multimodality Management of Merkel Cell Carcinoma
Mark J. Ott, MD;
Kenneth K. Tanabe, MD;
Michele A. Gadd, MD;
Paul Stark, MS;
Barbara L. Smith, MD, PhD;
Dianne M. Finkelstein, PhD;
Wiley W. Souba, MD, ScD
Arch Surg. 1999;134:388-393.
Hypothesis Merkel cell carcinoma is a rare dermal neuroendocrine carcinoma whose optimal treatment and prognostic factors are poorly defined. We hypothesize that high-risk patients with Merkel cell carcinoma are best treated with multimodality therapy.
Design A retrospective review of all patients (N = 33) with Merkel cell carcinoma treated at the Massachusetts General Hospital from January 1, 1980, to August 24, 1997. Median follow-up time was 37 months (range, 6-157 months).
Patients Adequate data for evaluation were available for 31 patients. Male to female distribution was 14 men and 17 women, with a median patient age of 68 years.
Main Outcome Measure Stage at presentation; factors associated with recurrence; and the effects of surgery, radiation therapy (XRT), and chemotherapy on recurrence, salvage, and survival rates.
Results There were 12 extremity, 11 head and neck, and 8 truncal tumors. There were 22 isolated primary tumors, 8 with additional clinically positive lymph nodes, and 1 with distant disease. Therapy was local excision with or without XRT in 19 patients, local resection and lymphadenectomy with or without XRT in 8 patients, and XRT alone in 4 patients with head and neck tumors. Fifteen patients developed recurrences (7 local, 8 nodal, and 10 distant). Median time to recurrence was 8 months (range, 3-48 months). There were 7 tumor-related deaths, 6 of which were associated with truncal lesions (P<.001). No locoregional recurrences occurred in patients with margins of resection of 2 cm or greater or adequate XRT. A multivariate analysis selected truncal location (P = .005) and nodal disease (P = .05) as predictors of mortality. Remission was possible in 5 patients with locoregional and 2 patients with distant recurrences.
Conclusions Merkel cell carcinoma is an aggressive dermal cancer with frequent nodal metastases; truncal tumors have the worst prognosis. Locoregional recurrence correlates with inadequate margins and lack of XRT, but remission is possible with multimodality therapy.
From the Division of Surgical Oncology, Department of Surgery (Drs Ott, Tanabe, Gadd, Smith, and Souba), and the Department of Biostatistics (Mr Stark and Dr Finkelstein), Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
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