[Continued complete remission of Merkel cell carcinoma with in-transit metastasis after treatment with isolated limb perfusion regional chemotherapy].
BACKGROUND
Primitive cutaneous neuroendocrine carcinoma or Merkel cell carcinoma is a rare tumor. It may be large since diagnosis is frequently delayed. The usual treatment is extensive surgical removal and radiotherapy.


METHODS
A 69-year-old woman presented with a large Merkel cell carcinoma of the right leg. MRI showed a tumor invading the deep layers together with several satellite lesions. There was no regional nodal or visceral metastasis. Regional chemotherapy involving isolated limb perfusion with melphalan was performed in order to avoid amputation. Complete response was achieved a few months later and continues 5 and a half years later with minor sequelae comprising cutaneous sclerosis, pigmentation and mild ankle stiffness.


CONCLUSIONS
Only five cases of Merkel cell carcinoma treated with isolated limb perfusion are reported in the literature: four of these involved local relapse and one was a primary tumor with regional lymph node involvement. Only one patient was still in complete remission 18 months after treatment. Isolated limb perfusion chemotherapy could thus be indicated in the treatment of advanced Merkel cell carcinoma of a limb in the absence of bone or regional lymph node involvement.
Grandpeix
C
C
Service de Dermatologie, Institut Gustave Roussy, Villejuif, France. cgrandpeix@yahoo.fr
Bonvalot
S
S
Petrow
P
P
Fraitag
S
S
Gounod
N
N
Avril
M F
MF
D000368:Aged; D000843:Ankle Joint / Q000503:physiopathology; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use*; D015266:Carcinoma, Merkel Cell / Q000188:drug therapy*; D010478:Chemotherapy, Cancer, Regional Perfusion; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007866:Leg; D008279:Magnetic Resonance Imaging; D008558:Melphalan / Q000627:therapeutic use*; D009361:Neoplasm Invasiveness; D010859:Pigmentation Disorders / Q000209:etiology; D016059:Range of Motion, Articular / Q000502:physiology; D012074:Remission Induction; D012598:Sclerosis; D012867:Skin / Q000473:pathology; D012878:Skin Neoplasms / Q000188:drug therapy*
D018906:Antineoplastic Agents, Alkylating; D008558:Melphalan