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December 1991

Merkel Cell CarcinomaPrognosis and Management

Author Affiliations

From the Departments of Surgery (Drs Yiengpruksawan, Coit, and Knapper), Epidemiology and Biostatistics (Dr Thaler), and Pathology (Dr Urmacher), Memorial Sloan-Kettering Cancer Center, New York, NY.

Arch Surg. 1991;126(12):1514-1519. doi:10.1001/archsurg.1991.01410360088014

• Seventy patients with Merkel cell carcinoma were treated at Memorial Sloan-Kettering Cancer Center between 1969 and 1989. The overall estimated 5-year survival rate was 64%. Factors predictive of improved survival included head and neck site and negative lymph nodes at presentation. Local recurrence was seen in 18 patients (26%) and did not correlate with patient-, tumor-, or treatment-related variables. Nine patients with local recurrence (50%) were free of disease following aggressive reoperation. Regional nodes were involved at some point during the course of the disease in forty-six patients (66%). Regional lymph node involvement was apparent within 2 years of diagnosis in 40 (87%) of 46 patients in whom it occurred. Systemic disease was nearly uniformly preceded by the appearance of nodal metastases and was uniformly fatal regardless of subsequent therapy. This suggests an orderly "cascade" pattern of spread for this tumor, in which elective regional lymph node dissection may be justified. Our recommendations for treatment include a wide excision of the primary tumor and either elective or early therapeutic regional node dissection. The role of adjuvant radiotherapy or chemotherapy remains unproven.

(Arch Surg. 1991;126:1514-1519)

Toker C.  Trabecular carcinoma of the skin . Arch Dermatol . 1972;105:107-110.Article
Tang CK, Toker C.  Trabecular carcinoma of the skin: an ultrastructural study . Cancer . 1978;42:2311-2321.Article
Kaplan EL, Meier P.  Nonparametric estimation from incomplete observations . J Am Stat Assoc . 1958;53:457-481.Article
Cox DR, Oakes D. Analysis of Survival Data . London, England: Chapman & Hall; 1984.
De Wolf-Peeter 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 behaviour . Cancer . 1980;46:1810-1816.Article
Szadowska A, Wozniak L, Lasota J, Giryn I, Mirecka B, Wolska H.  Neuroendocrine (Merkel cell) carcinoma of the skin: a clinico-morphological study of 13 cases . Histopathology . 1989;15:483-493.Article
Goepfert H, Remmler D, Silva EG, Wheeler B.  Merkel cell carcinoma (endocrine carcinoma of the skin) of the head and neck . Arch Otolaryngol Head Neck Surg . 1984;110:707-712.Article
Raaf JH, Urmacher C, Knapper WK, Shiu MH, Cheng EWK.  Trabecular (Merkel cell) carcinoma of the skin: treatment of primary, recurrent, and metastatic disease . Cancer . 1986;57:178-182.Article
Pilotti S, Rilke F, Bartoli C, Grisotti A.  Clinicopathologic correlations of cutaneous neuroendocrine Merkel cell carcinoma . J Clin Oncol . 1988;6:1863-1873.
Hitchcock CL, Bland KI, Lahey RG, Franzini D, Harris B, Copeland EM.  Neuroendocrine (Merkel cell) carcinoma of the skin: its natural history, diagnosis, and treatment . Ann Surg . 1988;207:201-207.Article
Tang CK, Toker C.  Trabecular carcinoma of the skin: further clinicopathologic and ultrastructural study . Mt Sinai J Med . 1979;46:516-523.
Sibley RK, Rosai J, Foucar E, Dehner LP, Bosi G.  Neuroendocrine (Merkel cell) carcinoma of the skin: a histologic and ultrastructural study of two cases . Am J Surg Pathol . 1980;4:211-221.Article
Warner TFCS, Uno H, Hafez GR, et al.  Merkel cells and Merkel cell tumors: ultrastructural, immunocytochemistry and review of the literature . Cancer . 1983;52:238-245.Article
Silva EG, Mackay B, Goepfert H, Burgess MA, Fields RS.  Endocrine carcinoma of the skin (Merkel cell carcinoma) . Pathol Annu . 1984;19:1-30.
Wick MR, Goellner JR, Scheithauer BW, Thomas JR, Sanchez NP, Schroeter AL:  Primary neuroendocrine carcinomas of the skin (Merkel cell tumors): a clinical, histologic, and ultrastructural study of thirteen cases . Am J Clin Pathol . 1983;79:6-13.
Gould V, Moll R, Moll I, Lee I, Franke W.  Biology of disease: neuroendocrine (Merkel) cells of the skin: hyperplasias, dysplasias, and neoplasms . Lab Invest . 1985;52:334-353.
Shaw JHF, Rumbull E.  Merkel cell tumor: clinical behavior and treatment . Br J Surg . 1991;78:138-142.Article
Balch CM.  The role of elective lymph node dissection in melanoma: rationale, results, and controversies . J Clin Oncol . 1988;6:163-172.
Schaefer GD, Erlandson RA, Urmacher C.  A cutaneous neoplasm in the skin of the abdomen that was excised and was followed by the development of bilateral axillary masses . Am J Dermatopathol . 1982;4:549-554.Article
Feun LG, Savaraj N, Legha SS, Silva EG, Benjamin RS, Burgess MA.  Chemotherapy for metastatic Merkel cell carcinoma: review of the M.D. Anderson Hospital's experience . Cancer . 1988;62:683-685.Article
Wynne CJ, Kearsley JH.  Merkel cell tumor: a chemosensitive skin cancer . Cancer . 1988;62:28-31.Article
Marks ME, Kim RY, Salter MM.  Radiotherapy as an adjunct in the management of Merkel cell carcinoma . Cancer . 1990;65:60-64.Article
Knox SJ, Kapp DS.  Hyperthermia and radiation therapy in the treatment of recurrent Merkel cell tumors . Cancer . 1988;62:1479-1486.Article
Pacella J, Ashby M, Ainslie J, Minty C.  The role of radiotherapy in the management of primary cutaneous neuroendocrine tumors (Merkel cell or trabecular carcinoma): experience at the Peter MacCallum Cancer Institute (Melbourne, Australia) . Int J Radiat Oncol Biol Phys . 1988;14:1077-1084.Article
Taxy JB, Ettinger DS, Wharam MD.  Primary small cell carcinoma of the skin . Cancer . 1980;46:2308-2311.Article