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Management of Merkel cell carcinoma: case series of 36 patients Muller A; Keus R; Neumann N; Lammering G; Schnabel TOncol Rep 2003[May]; 10 (3): 577-85Merkel cell carcinoma is a rare, highly malignant skin tumor with a predisposition for local, nodal and distant recurrence which should be managed in a multimodal approach. Here, we performed a retrospective analysis of 36 patients, treated from 1984 to 1994. In patients with stage I disease, locoregional recurrence after surgery alone occurred in 65% compared to 43% after excision and adjuvant radiotherapy. Although the difference in disease-specific survival was not significant (67% versus 52% at 5 years), combination therapy conferred a benefit for locoregional control and relapse-free survival (88 versus 58 months). The majority of failures (54%) occurred within the draining lymph nodes that were not treated in the initial approach and locoregional recurrence was strongly associated with a later systemic relapse (50% versus 0%). Salvage after localized recurrence was achieved in 67% of resectable cases. The high rate of nodal recurrence after surgery alone warrants the use of elective nodal treatment in patients with stage I disease. Surgical resection of the primary tumor should be followed by postoperative radiotherapy to the primary site and draining lymph nodes. Even after locoregional recurrence, a substantial proportion of patients is able to achieve long-term disease-free survival, particularly after complete resection and adjuvant irradiation.|Adult[MESH]|Aged[MESH]|Aged, 80 and over[MESH]|Antineoplastic Agents/therapeutic use[MESH]|Carcinoma, Merkel Cell/radiotherapy/surgery/*therapy[MESH]|Combined Modality Therapy[MESH]|Female[MESH]|Follow-Up Studies[MESH]|Humans[MESH]|Lymph Node Excision[MESH]|Male[MESH]|Middle Aged[MESH]|Neoplasm Recurrence, Local/radiotherapy/surgery/therapy[MESH]|Neoplasm Staging[MESH]|Prognosis[MESH]|Retrospective Studies[MESH]|Salvage Therapy[MESH]|Skin Neoplasms/radiotherapy/surgery/*therapy[MESH]|Survival Rate[MESH]|Treatment Outcome[MESH] |
