title: Merkel cell carcinoma: a review of management.
abstract: OBJECTIVE
  Merkel cell carcinoma is an uncommon but aggressive primary cutaneous neuroendocrine (small cell) carcinoma. The head and neck is a frequent site (50-60%) for presentation. The optimal treatment of patients with Merkel cell carcinoma remains debated with recent evidence adding support for a multimodality approach. Despite this the outcome for patients with unfavourable disease remains poor and in many series 25-50% of patients die as a direct result of Merkel cell carcinoma.
  
  
  RESULTS
  Wide excision (2-3 cm) of the primary lesion has been recommended, although achieving this is often impossible within the functional and cosmetic constraints of the head and neck. The well-documented responsiveness of this disease to radiotherapy and chemotherapy has strengthened the case for less radical surgery. Current best practice, as presented in recent publications, would support adjuvant wide-field radiotherapy, delivered after wide excision with negative microscopic margins, as best practice. The role of platinum-based chemotherapy remains under investigation.
  
  
  CONCLUSIONS
  Most patients with a Merkel cell carcinoma should be recommended wide-field adjuvant radiotherapy to encompass the primary site, in-transit tissue and first echelon lymph nodes following surgery. The benefit of adding chemotherapy is currently unproven and should be considered on an individual basis.
authors.affiliation: Head and Neck Cancer Service, Westmead Hospital, University of Sydney, Sydney, Australia. michael.veness@swahs.health.nsw.gov.au
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Veness
authors.forename: Carsten E
authors.initials: CE
authors.lastname: Palme
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Morgan
mesh_terms: D015266:Carcinoma, Merkel Cell / Q000175:diagnosis / Q000628:therapy*; D003131:Combined Modality Therapy; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D012878:Skin Neoplasms / Q000175:diagnosis / Q000628:therapy*