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Treatment Algorithm

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Merkel Cell Carcinoma

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Abstract

The treatment of Merkel cell carcinoma (MCC) is based on data from institutional case series. Local disease treatment consists of surgical excision, radiation monotherapy, or postoperative adjuvant radiation. In cases where tumor diameter ≤2 cm, surgical margins of 1 cm are reasonable. For tumors >2 cm, 2 cm margins are recommended. Due to the high rate of sentinel node positivity, sentinel lymph node biopsy with immunohistochemistry should be performed in nearly every case of MCC. In cases where excision prior to identification of the sentinel lymph node (SLN) may compromise identification of the SLN, adjuvant radiation therapy to the primary site, nodal beds, and in-transit lymphatics should be considered. Patients with a positive SLN should undergo completion lymph node dissection or radiation monotherapy to the regional basin. Multidisciplinary tumor boards are helpful in planning treatment for patients with regional or systemic disease. Treatment of regional disease consists of lymphadenectomy with or without adjuvant radiation, radiation monotherapy, or possibly adjuvant chemotherapy. Treatment of distant disease primarily consists of palliative chemotherapy, with the addition of radiation treatment and surgery where indicated.

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References

  1. National Comprehensive Cancer Network (NCCN). NCCN clinical practice guidelines in oncology. Merkel cell carcinoma version 1.2011. 2011. http://www.nccn.org/professionals/physician_gls/pdf/mcc.pdf. Accessed 19 Oct 2012.

  2. Gonzalez RJ, Padhya TA, Cherpelis BS, Prince MD, Aya-ay ML, Sondak VK, et al. The surgical management of primary and metastatic Merkel cell carcinoma. Curr Probl Cancer. 2011;34(1):77–96.

    Article  Google Scholar 

  3. Shaw JH, Rumball E. Merkel cell tumour: clinical behaviour and treatment. Br J Surg. 1991;78(2):138–42.

    Article  PubMed  CAS  Google Scholar 

  4. Allen PJ, Busam K, Hill AD, Stojadinovic A, Coit DG. Immunohistochemical analysis of sentinel lymph nodes from patients with Merkel cell carcinoma. Cancer. 2001;92(6):1650–5.

    Article  PubMed  CAS  Google Scholar 

  5. 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(10):2300–9.

    Article  PubMed  Google Scholar 

  6. 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(3):204–8.

    Article  PubMed  CAS  Google Scholar 

  7. Ott MJ, Tanabe KK, Gadd MA, Stark P, Smith BL, Finkelstein DM, et al. Multimodality management of Merkel cell carcinoma. Arch Surg. 1999;134(4):388–92; discussion 392–3.

    Article  PubMed  CAS  Google Scholar 

  8. O’Connor WJ. Merkel cell carcinoma. Comparison of Mohs micrographic surgery and wide excision in eighty-six patients. Dermatol Surg. 1997;23:929–33.

    Article  PubMed  Google Scholar 

  9. Eng TY, Boersma MG, Fuller CD, Goytia V, Jones WE, Joyner M, et al. A comprehensive review of the treatment of Merkel cell carcinoma. Am J Clin Oncol. 2007;30(6):624–36.

    Article  PubMed  Google Scholar 

  10. Veness MJ. Merkel cell carcinoma (primary cutaneous neuroendocrine carcinoma): an overview on management. Australas J Dermatol. 2006;47(3):160–5.

    Article  PubMed  Google Scholar 

  11. Boyer J. Local control of primary Merkel cell carcinoma: review of 45 cases treated with Mohs micrographic surgery with and without adjuvant radiation. J Am Acad Dermatol. 2002;47(6):885–92.

    Article  PubMed  Google Scholar 

  12. Lewis KG, Weinstock MA, Weaver AL, Otley CC. Adjuvant local irradiation for Merkel cell carcinoma. Arch Dermatol. 2006;142(6):693–700.

    Article  PubMed  Google Scholar 

  13. Mojica P, Smith D, Ellenhorn JD. Adjuvant radiation therapy is associated with improved survival in Merkel cell carcinoma of the skin. J Clin Oncol. 2007;25(9): 1043–7.

    Article  PubMed  Google Scholar 

  14. Pape E, Rezvoy N, Penel N, Salleron J, Martinot V, Guerreschi P, et al. Radiotherapy alone for Merkel cell carcinoma: a comparative and retrospective study of 25 patients. J Am Acad Dermatol. 2011;65(5):983–90.

    Google Scholar 

  15. Veness M, Foote M, Gebski V, Poulsen M. The role of radiotherapy alone in patients with Merkel cell carcinoma: reporting the Australian experience of 43 patients. Int J Radiat Oncol Biol Phys. 2010;78(3): 703–9.

    Article  PubMed  Google Scholar 

  16. Bichakjian 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):1–12.

    Article  PubMed  Google Scholar 

  17. Mehrany K, Otley C, Weenig R. A meta-analysis of the prognostic significance of sentinel lymph node status in Merkel cell carcinoma. Dermatol Surg. 2002;28(2):113–7.

    Article  PubMed  Google Scholar 

  18. Lemos BD, Storer BE, Iyer JG, Phillips JL, Bichakjian CK, Fang LC, et al. Pathologic nodal evaluation improves prognostic accuracy in Merkel cell carcinoma: analysis of 5823 cases as the basis of the first consensus staging system. J Am Acad Dermatol. 2010;63(5):751–61.

    Article  PubMed  Google Scholar 

  19. 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(6):685.

    Article  PubMed  Google Scholar 

  20. Hitchcock CL, Bland KI, Laney RG, Franzini D, Harris B, Copeland EM. Neuroendocrine (Merkel cell) carcinoma of the skin. Its natural history, diagnosis, and treatment. Ann Surg. 1988;207(2):201–7.

    Article  PubMed  CAS  Google Scholar 

  21. Shnayder Y, Weed DT, Arnold DJ, Gomez-Fernandez C, Bared A, Goodwin WJ, et al. Management of the neck in Merkel cell carcinoma of the head and neck: University of Miami experience. Head Neck. 2008;30(12):1559–65.

    Article  PubMed  Google Scholar 

  22. Maza S, Trefzer U, Hofmann M, Schneider S, Voit C, Krössin T, et al. Impact of sentinel lymph node biopsy in patients with Merkel cell carcinoma: results of a prospective study and review of the literature. Eur J Nucl Med Mol Imaging. 2006;33(4):433–40.

    Article  PubMed  Google Scholar 

  23. Sarnaik AA, Zager JS, Cox LE, Ochoa TM, Messina JL, Sondak VK. Routine omission of sentinel lymph node biopsy for Merkel cell carcinoma. J Clin Oncol. 2010;28(1):e7.

    Article  PubMed  Google Scholar 

  24. Su LD, Lowe L, Bradford CR, Yahanda AI, Johnson TM, Sondak VK. Immunostaining for cytokeratin 20 improves detection of micrometastatic Merkel cell carcinoma in sentinel lymph nodes. J Am Acad Dermatol. 2002;46(5):661–6.

    Article  PubMed  Google Scholar 

  25. Schwartz JL, Griffith KA, Lowe L, Wong SL, McLean SA, Fullen DR, et al. Features predicting sentinel lymph node positivity in Merkel cell carcinoma. J Clin Oncol. 2011;29(8):1036–41.

    Article  PubMed  Google Scholar 

  26. Kokoska ER, Kokoska MS, Collins BT, Stapleton DR, Wade TP. Early aggressive treatment for Merkel cell carcinoma improves outcome. Am J Surg. 1997; 174(6):688–93.

    Article  PubMed  CAS  Google Scholar 

  27. Stadelmann WK, Cobbins L, Lentsch EJ. Incidence of nonlocalization of sentinel lymph nodes using preoperative lymphoscintigraphy in 74 consecutive head and neck melanoma and Merkel cell carcinoma patients. Ann Plast Surg. 2004;52(6):546–9; discussion 550.

    Article  PubMed  Google Scholar 

  28. Sian KU, Wagner JD, Sood R, Park HM, Havlik R, Coleman JJ. Lymphoscintigraphy with sentinel lymph node biopsy in cutaneous Merkel cell carcinoma. Ann Plast Surg. 1999;42(6):679–82.

    Article  PubMed  CAS  Google Scholar 

  29. Fang LC, Lemos B, Douglas J, Iyer J, Nghiem P. Radiation monotherapy as regional treatment for lymph node-positive Merkel cell carcinoma. Cancer. 2010;116(7):1783–90.

    Article  PubMed  Google Scholar 

  30. Eng TY, Naguib M, Fuller CD, Jones WE, Herman TS. Treatment of recurrent Merkel cell carcinoma: an analysis of 46 cases. Am J Clin Oncol. 2004;27(6): 576–83.

    Article  PubMed  Google Scholar 

  31. De Wolff-Peeters C, Marien K, Mebis J, Desmet V. A cutaneous APUDoma or Merkel cell tumor? A morphologically recognizable tumor with a biological and histological malignant aspect in contrast with its clinical behavior. Cancer. 1980;46(8):1810–6.

    Article  PubMed  Google Scholar 

  32. Tai PT, Yu E, Winquist E, Hammond A, Stitt L, Tonita J, et al. Chemotherapy in neuroendocrine/Merkel cell carcinoma of the skin: case series and review of 204 cases. J Clin Oncol. 2000;18(12):2493–9.

    PubMed  CAS  Google Scholar 

  33. Voog E, Biron P, Martin JP, Blay JY. Chemotherapy for patients with locally advanced or metastatic Merkel cell carcinoma. Cancer. 1999;85(12): 2589–95.

    Article  PubMed  CAS  Google Scholar 

  34. Rockville Merkel Cell Carcinoma Group. Merkel cell carcinoma: recent progress and current priorities on etiology, pathogenesis, and clinical management. J Clin Oncol. 2009;27(24):4021–6.

    Article  Google Scholar 

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Authors and Affiliations

  1. Division of Dermatology and Dermatologic Surgery, Scripps Clinic, 10666 North Torrey Pines Road, MS112A, La Jolla, CA, 92037, USA

    Douglas Winstanley & Seaver Soon

Authors
  1. Douglas Winstanley
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  2. Seaver Soon
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Correspondence to Douglas Winstanley .

Editor information

Editors and Affiliations

  1. Department of Dermatology, Northwestern University, Chicago, 60611, Illinois, USA

    Murad Alam

  2. University Hospitals Case Medical Center, Department of Dermatology, Case Western Reserve University, Cleveland, 44106, Ohio, USA

    Jeremy S. Bordeaux

  3. Department of Dermatology, University of California, San Francisco, San Francisco, 94115, California, USA

    Siegrid S. Yu

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Winstanley, D., Soon, S. (2013). Treatment Algorithm. In: Alam, M., Bordeaux, J., Yu, S. (eds) Merkel Cell Carcinoma. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6608-6_11

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  • DOI: https://doi.org/10.1007/978-1-4614-6608-6_11

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  • Publisher Name: Springer, New York, NY

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  • Online ISBN: 978-1-4614-6608-6

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