Annals of Surgical Oncology

, 16:2985 | Cite as

Single-Institution Series of Early-Stage Merkel Cell Carcinoma: Long-Term Outcomes in 95 Patients Managed with Surgery Alone

  • Emilio Bajetta
  • Luigi Celio
  • Marco Platania
  • Salvatore Lo Vullo
  • Roberto Patuzzo
  • Andrea Maurichi
  • Mario Santinami
Melanomas

Abstract

Aim

To determine the long-term outcomes of early-stage Merkel cell carcinoma (MCC) patients managed with surgery alone.

Methods

Ninety-five consecutive patients were reviewed. Patients were treated by wide local excision. Clinically negative regional nodes were either followed up (n = 42) or staged with sentinel lymph node biopsy (n = 21), and clinically positive nodes underwent lymph node dissection (n = 32).

Results

Median follow-up was 65 months. A total of 45 (47%) patients relapsed, with 80% of the recurrences occurring within 2 years and 96% within 5 years. The 5-year crude cumulative incidence (CCI) of recurrence and disease-specific survival (DSS) were 52% and 67%, respectively. CCI of local 5-year recurrence was 5% for the study cohort. Patients with MCC in the head and neck region had a 5-year local-recurrence CCI of 19%, and patients with MCC in the extremity and trunk region had a 5-year local-recurrence CCI of 2% (P = 0.007). Comparing patients with ≤ 2 versus > 2 metastatic lymph nodes, the 5-year regional-recurrence CCI was 0% versus 39% (P = 0.004). The 5-year distant-recurrence CCI was higher in clinically node-positive patients compared with node-negative patients (37% versus 12%; P = 0.005). Patients with MCC in the head and neck region experienced no distant recurrences, patients with MCC in the extremity and trunk region had a 5-year distant-recurrence CCI of 22%, and patients with occult primary had a 5-year distant-recurrence CCI of 49% (P = 0.023). The 5-year DSS rate was 80% for pathologically node-negative patients.

Conclusion

The prognosis for surgically managed early-stage MCC is variable. Thus multidisciplinary tumor-board consultation is needed to optimize individual patient management.

Notes

Acknowledgment

The authors would like to thank the ITMO scientific service for data management and assistance in editing the manuscript. Special thanks are due to Dr. Arpine Gevorgyan for her skilful assistance in writing the manuscript.

References

  1. 1.
    Tocker C. Trabecular carcinoma of the skin. Arch Dermatol. 1972;105:107–10.CrossRefGoogle Scholar
  2. 2.
    Hodgson NC. Merkel cell carcinoma: changing incidence trends. J Surg Oncol. 2005;89:1–4.CrossRefPubMedGoogle Scholar
  3. 3.
    Bajetta E, Platania M, Catena L, Bichisao E, Fabbri A, Procopio G, et al. Merkel cell carcinoma after liver transplantation: a case report. Tumori. 2007;93:323–6.PubMedGoogle Scholar
  4. 4.
    Koljonen V. Merkel cell carcinoma. World J Surg Oncol. 2006;4:7.CrossRefPubMedGoogle Scholar
  5. 5.
    Yiengpruksawan A, Coit DG, Thaler HT, Urmacher C, Knapper WK. Merkel cell carcinoma. Prognosis and management. Arch Surg. 1991;126:1514–9.PubMedGoogle Scholar
  6. 6.
    Shaw JHF, Rumball E. Merkel cell tumour: clinical behaviour and treatment. Br J Surg. 1991;78:138–42.CrossRefPubMedGoogle Scholar
  7. 7.
    Eng TY, Boersma MG, Fuller CD, Goytia V, Jones WE III, Joyner M, et al. A comprehensive review of the treatment of Merkel cell carcinoma. Am J Clin Oncol. 2007;30:624–36.CrossRefPubMedGoogle Scholar
  8. 8.
    Hill ADK, Brady MS, Coit DG. Intraoperative mapping and sentinel lymph node biopsy for Merkel cell carcinoma. Br J Surg. 1999;86:518–21.CrossRefPubMedGoogle Scholar
  9. 9.
    Garneski KM, Nghiem P. Merkel cell carcinoma adjuvant therapy: current data support radiation but not chemotherapy. J Am Acad Dermatol. 2007;57:166–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Kokoska ER, Kokoska MS, Collins BT, Stapleton DR, Wade TP. Early aggressive treatment for Merkel cell carcinoma improves outcome. Am J Surg. 1997;174:688–93.CrossRefPubMedGoogle Scholar
  11. 11.
    Meeuwissen JA, Bourne RG, Kearsley JH. The importance of postoperative radiation therapy in the treatment of Merkel cell carcinoma. Int J Radiat Oncol Biol Phys. 1995;31:323–31.Google Scholar
  12. 12.
    Veness MJ, Perera L, McCourt J, Shannon J, Hughes TM, Morgan GJ, et al. Merkel cell carcinoma: improved outcome with adjuvant radiotherapy. ANZ J Surg. 2005;75:275–81.CrossRefPubMedGoogle Scholar
  13. 13.
    Mojica P, Smith D, Ellenhorn JDI. Adjuvant radiation therapy is associated with improved survival in Merkel cell carcinoma of the skin. J Clin Oncol. 2007;25:1043–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Mann GB, Allen PJ, Coit DG. Merkel cell carcinoma. ANZ J Surg. 1999;69:87.CrossRefGoogle Scholar
  15. 15.
    Boyer JD, Zitelli JA, Brodland DG, D’Angelo G. Local control of primary Merkel cell carcinoma: review of 45 cases treated with Mohs micrographic surgery with and without adjuvant radiotherapy. J Am Acad Dermatol. 2002;47:885–92.CrossRefPubMedGoogle Scholar
  16. 16.
    Allen PJ, Bowne WB, Jaques DP, Brennan MF, Busam K, Coit DG. Merkel cell carcinoma: prognosis and treatment of patients from a single institution. J Clin Oncol. 2005;23:2300–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Sobin LH, Wittekind C, editors. TNM classification of malignant tumours. 6th ed. Hoboken, NJ: Wiley; 2002.Google Scholar
  18. 18.
    Marubini E, Valsecchi MG. Analyzing survival data from clinical trials and observational studies. Chichester, UK: Wiley; 1995.Google Scholar
  19. 19.
    Gray RJ. A class of k-sample tests for comparing the cumulative incidence of a competing risk. Ann Stat. 1988;16:1141–54.CrossRefGoogle Scholar
  20. 20.
    Koljonen V, Bohling T, Granhroth G, Tukiainen E. Merkel cell carcinoma: a clinicopathological study of 34 patients. Eur J Surg Oncol. 2003;29:607–10.CrossRefPubMedGoogle Scholar
  21. 21.
    Medina-Franco H, Urist MM, Fiveash J, Heslin MJ, Bland KI, Beenken SW. Multimodality treatment of Merkel cell carcinoma: case series and literature review of 1024 cases. Ann Surg Oncol. 2001;8:204–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Dinh VD, Feun L, Elgart G, Savaraj N. Merkel cell carcinomas. Hematol Oncol Clin North Am 2007;21:527–44.CrossRefPubMedGoogle Scholar
  23. 23.
    Bickakjian CK, Lowe L, Lao CD, Sandler HM, Bradford CR, Johnson TM, et al. Merkel cell carcinoma: critical review with guidelines for multidisciplinary management. Cancer. 2007;110:1–12.CrossRefGoogle Scholar
  24. 24.
    Allen PJ, Zhang ZF, Coit DG. Surgical management of Merkel cell carcinoma. Ann Surg. 1999;229:97–105.CrossRefPubMedGoogle Scholar
  25. 25.
    O’Connor WJ, Roenigk RK, Brodland DG. Merkel cell carcinoma. Comparison of Mohs micrographic surgery and wide excision in eighty-six patients. Dermatol Surg. 1997;23:929–33.CrossRefPubMedGoogle Scholar
  26. 26.
    Jabbour J, Cumming R, Scolyer RA, Hruby G, Thompson JF, Lee S. Merkel cell carcinoma: assessing the effect of wide local excision, lymph node dissection, and radiotherapy on recurrence and survival in early-stage disease—Results from a review of 82 consecutive cases diagnosed between 1992 and 2004. Ann Surg Oncol. 2007;14:1943–52.CrossRefPubMedGoogle Scholar
  27. 27.
    Ott MJ, Tanabe KK, Gadd MA, Stark P, Smith BL, Finkelstein DM, et al. Multimodality management of Merkel cell carcinoma. Arch Surg. 1999;134:388–93.CrossRefPubMedGoogle Scholar
  28. 28.
    Gillenwater AM, Hessel AC, Morrison WH, Burgess MA, Silva EG, Roberts D, et al. Merkel cell carcinoma of the head and neck: effect of surgical excision and radiation on recurrence and survival. Arch Otolaryngol Head Neck Surg. 2001;127:149–54.PubMedGoogle Scholar
  29. 29.
    Sandel HD, Day T, Richardson MS, Scarlett M, Gutman KA. Merkel cell carcinoma: does tumour size or depth of invasion correlate with recurrence, metastasis, or patient survival? Laryngoscope. 2006;116:791–5.CrossRefPubMedGoogle Scholar
  30. 30.
    Liao PB. Merkel cell carcinoma. Dermatol Ther. 2008;21:447–51.CrossRefPubMedGoogle Scholar
  31. 31.
    Mortier L, Mirabel X, Fournier C, Piette F, Lartigau E. Radiotherapy alone for primary Merkel cell carcinoma. Arch Dermatol. 2003;139:1587–90.CrossRefPubMedGoogle Scholar
  32. 32.
    Gupta SG, Wang LC, Penas PF, Gellenthin M, Lee SJ, Nghiem P. Sentinel lymph node biopsy for evaluation and treatment of patients with Merkel cell carcinoma: the Dana-Farber experience and meta-analysis of the literature. Arch Dermatol. 2006;142:685–90.CrossRefPubMedGoogle Scholar
  33. 33.
    Messina JL, Reintgen DS, Cruse CW, Rappaport DP, Berman C, Fenske NA, et al. Selective lymphadenectomy in patients with Merkel cell (cutaneous neuroendocrine) carcinoma. Ann Surg Oncol. 1997;4:389–95.CrossRefPubMedGoogle Scholar
  34. 34.
    Senchenkov A, Barnes SA, Moran SL. Predictors of survival and recurrence in the surgical treatment of Merkel cell carcinoma of the extremities. J Surg Oncol. 2007;95:229–34.CrossRefPubMedGoogle Scholar
  35. 35.
    Mehrany K, Otley CC, Weenig RH, Phillips PK, Roenigk RK, Hguyen TH. A meta-analysis of the prognostic significance of sentinel lymph node status in Merkel cell carcinoma. Dermatol Surg. 2002;28:113–7.CrossRefPubMedGoogle Scholar
  36. 36.
    Clark JR, Veness MJ, Gilbert R, O’Brien CJ, Gullane PJ. Merkel cell carcinoma of the head and neck: is adjuvant radiotherapy necessary? Head and Neck. 2007;29:249–57.CrossRefPubMedGoogle Scholar
  37. 37.
    National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: Merkel cell carcinoma. v.1.2009. Available: http://www.nccn.org/professionals/physician_gls/PDF/mcc.pdf. Accessed January 15, 2009.
  38. 38.
    Poulsen M, Rischin D, Walpole E, et al. High-risk Merkel cell carcinoma of the skin treated with synchronous carboplatin/etoposide and radiation: a Trans-Tasman Radiation Oncology Group Study-TROG 96:07. J Clin Oncol. 2003;21:4371–6.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2009

Authors and Affiliations

  • Emilio Bajetta
    • 1
  • Luigi Celio
    • 1
  • Marco Platania
    • 1
  • Salvatore Lo Vullo
    • 2
  • Roberto Patuzzo
    • 3
  • Andrea Maurichi
    • 3
  • Mario Santinami
    • 3
  1. 1.Department of MedicineFondazione IRCCS “Istituto Nazionale Tumori”MilanItaly
  2. 2.Unit of Medical Statistics and BiometryFondazione IRCCS “Istituto Nazionale Tumori”MilanItaly
  3. 3.Department of SurgeryFondazione IRCCS “Istituto Nazionale Tumori”MilanItaly

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