title: A meta-analysis of the prognostic significance of sentinel lymph node status in Merkel cell carcinoma.
abstract: BACKGROUND
  Merkel cell carcinoma is an aggressive cutaneous neoplasm with a high propensity to metastasize to lymph nodes.
  
  
  OBJECTIVE
  The objective of this study was to determine the prognostic significance of sentinel lymph node status in patients with Merkel cell carcinoma.
  
  
  METHODS
  A meta-analysis of case series of patients with Merkel cell carcinoma managed with sentinel lymph node biopsy was performed.
  
  
  RESULTS
  Forty of 60 patients (67%) had a biopsy-negative sentinel lymph node; 97% of this group had no recurrence at 7.3 months median follow-up. Twenty patients (33%) had a biopsy-positive sentinel lymph node; 33% of this group experienced local, regional, or systemic recurrence at 12 months median follow-up. Risk of recurrence or metastasis was 19-fold greater in biopsy-positive patients (odds ratio, 18.9; p = 0.005). None of 15 biopsy-positive patients who underwent therapeutic lymph node dissection experienced a regional recurrence; 3 of 4 who did not receive therapeutic lymphadenectomy experienced regional recurrence.
  
  
  CONCLUSIONS
  Sentinel lymph node positivity is strongly predictive of a high short-term risk of recurrence or metastasis in patients with Merkel cell carcinoma. Therapeutic lymph node dissection appears effective in preventing short-term regional nodal recurrence. Aggressive adjuvant treatment should be considered for patients with positive sentinel lymph nodes.
authors.affiliation: Department of Dermatology, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Khosrow
authors.initials: K
authors.lastname: Mehrany
authors.forename: Clark C
authors.initials: CC
authors.lastname: Otley
authors.forename: Roger H
authors.initials: RH
authors.lastname: Weenig
authors.forename: P Kim
authors.initials: PK
authors.lastname: Phillips
authors.forename: Randall K
authors.initials: RK
authors.lastname: Roenigk
authors.forename: Tri H
authors.initials: TH
authors.lastname: Nguyen
mesh_terms: D015266:Carcinoma, Merkel Cell / Q000556:secondary*; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D011379:Prognosis; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000473:pathology*