title: Lymphoscintigraphy, sentinel lymph node biopsy, and Mohs micrographic surgery in the treatment of Merkel cell carcinoma.
abstract: BACKGROUND
  Merkel cell carcinoma (MCC) is an aggressive cutaneous malignancy with a high incidence of occult nodal metastases. MCC is believed to be similar in natural history to thick or ulcerated melanomas in its propensity for locoregional recurrence and early lymph node metastasis. Studies have shown that nodal status is statistically correlated to survival in MCC. Radiolocalization and superselective lymph node biopsy is a recent technique that has been proven to be of great value in evaluating the status of occult lymph node disease in malignant melanoma and breast cancer patients.
  
  
  OBJECTIVE
  In previously untreated patients, an orderly progression of metastases is observed for both cutaneous carcinomas and malignant melanomas and is anticipated for MCC. METHODS/RESULTS. We present two patients with MCC of the head and neck who underwent simultaneous Mohs micrographic surgery and sentinel lymph node biopsy with intraoperative radiolocalization.
  
  
  CONCLUSIONS
  Sentinel lymph node biopsy and intraoperative lymphoscintigraphy may prove to be a useful technique in evaluating occult nodal involvement and in limiting the potentially unnecessary morbidity of more comprehensive lymph node dissections in MCC patients who do not yet have metastatic involvement.
authors.affiliation: Department of Dermatology, Roswell Park Cancer Insititute, Buffalo, New York, USA. nzeitouni@SC3103.med.buffalo.edu
authors.forename: N C
authors.initials: NC
authors.lastname: Zeitouni
authors.forename: R T
authors.initials: RT
authors.lastname: Cheney
authors.forename: M D
authors.initials: MD
authors.lastname: Delacure
mesh_terms: D000368:Aged; D001706:Biopsy; D015266:Carcinoma, Merkel Cell / Q000175:diagnosis* / Q000556:secondary / Q000601:surgery*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D015580:Mohs Surgery; D011877:Radionuclide Imaging; D012878:Skin Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*