title: Local control of primary Merkel cell carcinoma: review of 45 cases treated with Mohs micrographic surgery with and without adjuvant radiation.
abstract: BACKGROUND
  Optimal treatment of primary Merkel cell carcinoma (MCC) is unknown. High local recurrence rates after excision alone compel some physicians to advocate postoperative radiation therapy to improve local control.
  
  
  OBJECTIVE
  We wondered whether marginal recurrence and survival rates differed between patients with primary MCC treated with Mohs surgery alone and those treated with Mohs surgery and adjuvant postoperative radiation.
  
  
  METHODS
  A collaborative retrospective study was performed; the study group consisted of 45 patients with stage I MCC who were histologically and clinically free of disease after Mohs excision. Twenty patients subsequently received elective postoperative radiation to the primary site, and 25 patients had no adjuvant radiation therapy.
  
  
  RESULTS
  One marginal recurrence (4%) and 3 in-transit metastases were observed in the Mohs surgery alone group, whereas none were observed in the Mohs surgery and radiation group. The proportion of patients with these events was not significantly different between treatment groups. Overall survival, relapse-free survival, and disease-free survival were not significantly different between treatment groups.
  
  
  CONCLUSIONS
  Adjuvant radiation appears unessential to secure local control of primary MCC lesions completely excised with Mohs micrographic surgery. Adjuvant radiation is recommended for patients unable to have complete excision or if complete histologic margin control is unavailable and should be considered for patients with large or recurrent tumors.
authors.affiliation: National Naval Medical Center, Bethesda, Maryland, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Boyer
authors.forename: John A
authors.initials: JA
authors.lastname: Zitelli
authors.forename: David G
authors.initials: DG
authors.lastname: Brodland
authors.forename: Gina
authors.initials: G
authors.lastname: D'Angelo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D015266:Carcinoma, Merkel Cell / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015580:Mohs Surgery / Q000379:methods*; D011379:Prognosis; D011829:Radiation Dosage; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome