title: Management of Merkel cell carcinoma: case series of 36 patients.
abstract: Merkel cell carcinoma is a rare, highly malignant skin tumor with a predisposition for local, nodal and distant recurrence which should be managed in a multimodal approach. Here, we performed a retrospective analysis of 36 patients, treated from 1984 to 1994. In patients with stage I disease, locoregional recurrence after surgery alone occurred in 65% compared to 43% after excision and adjuvant radiotherapy. Although the difference in disease-specific survival was not significant (67% versus 52% at 5 years), combination therapy conferred a benefit for locoregional control and relapse-free survival (88 versus 58 months). The majority of failures (54%) occurred within the draining lymph nodes that were not treated in the initial approach and locoregional recurrence was strongly associated with a later systemic relapse (50% versus 0%). Salvage after localized recurrence was achieved in 67% of resectable cases. The high rate of nodal recurrence after surgery alone warrants the use of elective nodal treatment in patients with stage I disease. Surgical resection of the primary tumor should be followed by postoperative radiotherapy to the primary site and draining lymph nodes. Even after locoregional recurrence, a substantial proportion of patients is able to achieve long-term disease-free survival, particularly after complete resection and adjuvant irradiation.
authors.affiliation: Department of Radiation Therapy and Radiation Oncology, Heinrich-Heine-University, Moorenstrasse 5, D-40225 Dusseldorf, Germany. a.mueller@uni-duesseldorf.de
authors.forename: Anja
authors.initials: A
authors.lastname: Müller
authors.forename: Ronald
authors.initials: R
authors.lastname: Keus
authors.forename: Norbert
authors.initials: N
authors.lastname: Neumann
authors.forename: Guido
authors.initials: G
authors.lastname: Lammering
authors.forename: Thomas
authors.initials: T
authors.lastname: Schnabel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D015266:Carcinoma, Merkel Cell / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D016879:Salvage Therapy; D012878:Skin Neoplasms / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents