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Radiation, Lymph Node Dissection, or Both: Management of Lymph Node Micrometastases from Merkel Cell Carcinoma

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Regional lymph node micrometastases from Merkel cell carcinoma (MCC) can be treated with completion lymph node dissection (CLND) and/or radiation therapy (RT). It is unclear how these options compare in terms of survival benefits for patients.

Patients and Methods

This retrospective cohort study used data from years 2012–2019 of the National Cancer Database. Patients with MCC and clinically negative, but pathologically positive, lymph node metastases who received RT to and/or CLND of the regional lymph node basin were included. Inverse probability weight balancing was performed using covariates followed by Cox proportional hazards modeling for survival analysis.


A total of 962 patients were included [median (interquartile range) age, 74 (67–80) years, 662 (68.8%) male patients, 926 (96.3%) white patients]. The majority (63%, n = 606) had a CLND only, while 18% (n = 173) had RT only, and 19% (n = 183) had both CLND and RT. From 2016 to 2019, usage of RT only increased from 10% to 31.8%. Multivariate analysis demonstrated that treatment modality was not associated with survival [RT versus CLND, hazard ratio (HR) 0.842, 95% confidence interval (CI) 0.621–1.142, p = 0.269, RT+CLND versus CLND, HR 1.029, 95% CI 0.775–1.367, p = 0.844]. This persisted after balancing weights (RT versus CLND, HR 0.837, 95% CI 0.614–1.142, p = 0.262, RT+CLND versus CLND, HR 1.085, 95% CI 0.801–1.470, p = 0.599).


The usage of RT for nodal micrometastasis in MCC is increasing as compared with CLND. This strategy appears to be safe, with no significant difference in survival outcomes.

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Data Availability

All data used in this study are from the National Cancer Database ( The authors do not own this data and hence are not permitted to share them in the original form.


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Authors and Affiliations



Study conception or design was carried out by KLM, CES, GNT, GCK, and JTM. Data acquisition, analysis, or interpretation was carried out by KLM, CES, and LJK. Drafting or critically revising the work was carried out by KLM, CES, GNT, LJK, JNL, GCK, and JTM.

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Correspondence to Giorgos C. Karakousis MD.

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Ma, K.L., Sharon, C.E., Tortorello, G.N. et al. Radiation, Lymph Node Dissection, or Both: Management of Lymph Node Micrometastases from Merkel Cell Carcinoma. Ann Surg Oncol 30, 4345–4355 (2023).

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