title: Early aggressive treatment for Merkel cell carcinoma improves outcome.
abstract: BACKGROUND
  Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine tumor of dermal origin. Treatment recommendations are limited owing to a paucity of retrospective data and an absence of prospective data. The objective of this study was to determine current therapeutic trends and their impact upon outcome.
  
  
  METHODS
  A retrospective study (1983 to 1996) was performed with patients from the Department of Defense and our University-affiliated hospitals.
  
  
  RESULTS
  Thirty-five patients were evaluated with a mean follow-up of 31 months. Overall, 1- and 2-year survival rates were 80% and 50%, respectively. Patients undergoing wide local excision, prophylactic lymph node dissection, and adjuvant radiotherapy had significantly decreased locoregional and distant recurrence rates and improved survival when compared with their counterparts. Adjuvant chemotherapy did not diminish recurrence rates nor improve survival. Both locoregional and distant recurrence significantly decreased survival.
  
  
  CONCLUSIONS
  These data suggest that early aggressive treatment for MCC improves both tumor control and survival, whereas the early use of chemotherapy does not improve outcome.
authors.affiliation: Department of Surgery, Saint Louis University Health Sciences Center, Missouri 63110, USA.
authors.forename: E R
authors.initials: ER
authors.lastname: Kokoska
authors.forename: M S
authors.initials: MS
authors.lastname: Kokoska
authors.forename: B T
authors.initials: BT
authors.lastname: Collins
authors.forename: D R
authors.initials: DR
authors.lastname: Stapleton
authors.forename: T P
authors.initials: TP
authors.lastname: Wade
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015266:Carcinoma, Merkel Cell / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D016896:Treatment Outcome