title: Merkel cell carcinoma in South East Scotland, 1993-2003.
abstract: OBJECTIVE
  Merkel cell carcinoma (MCC) is a rare cutaneous malignancy. The aims of this study were to look at the incidence and distribution of MCC in a predominantly skin type I Caucasian population, review overall management of the disease and assess patient outcomes.
  
  
  METHODS
  Cases were identified through the regional pathology database. Twenty patients were diagnosed with MCC over a 10-year period (1993-2003) and managed at the Regional Plastic Surgery Unit at St John's Hospital, Livingston.
  
  
  RESULTS
  The disease incidence was found to be 0.133 per 100,000 per annum. All patients were Caucasian, seven males and 13 females (1:1.9 ratio). The mean age at presentation was 77 years (range 58-93 years). The majority of lesions were found to be stage IA (80%), located in the head and neck region. There were two cases (10%) with stage II disease and two (10%) with stage III disease (both with liver metastases) at the time of diagnosis. All patients were managed operatively. Seventeen of the 20 had wide local excisions; of the remaining three, two were only suitable for debulking procedures and one patient (stage II) had only a diagnostic biopsy, refusing intervention thereafter. One patient received adjuvant chemoradiotherapy.
  
  
  CONCLUSIONS
  Surgery remains the mainstay of treatment but adjuvant therapy, in particular chemotherapy, is problematic in a frail, elderly population.
authors.affiliation: Department of Plastic Surgery, St John's Hospital, Livingston, Edinburgh, UK.
authors.forename: L A
authors.initials: LA
authors.lastname: Mills
authors.forename: A J
authors.initials: AJ
authors.lastname: Durrani
authors.forename: J D
authors.initials: JD
authors.lastname: Watson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015266:Carcinoma, Merkel Cell / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012606:Scotland / Q000453:epidemiology; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D016896:Treatment Outcome; D044465:White People