We read with great interest the Resident's Forum article in the June 2009 issue of Archives by Ruan and Reeves, who presented their experience with Merkel cell carcinoma, a review of the literature, and a proposed algorithm for the management of this neoplasm.1 The authors insist on “the heterogeneity of this cancer” and the lack of evidence regarding its management. Our own experience will add 2 more arguments to this heterogeneity: (1) these neoplasms can arise from the lymph nodes in the absence of any lesion in the skin or the mucosa, and (2) prolonged survival can be achieved with an aggressive multimodal approach despite lymph node involvement.
Claire C, Pablo O. More About the “Heterogeneity” of Merkel Cell Carcinoma. Arch Surg. 2010;145(1):104-105. doi:10.1001/archsurg.2009.239