title: Single-institution series of early-stage Merkel cell carcinoma: long-term outcomes in 95 patients managed with surgery alone.
abstract: OBJECTIVE
  To determine the long-term outcomes of early-stage Merkel cell carcinoma (MCC) patients managed with surgery alone.
  
  
  METHODS
  Ninety-five consecutive patients were reviewed. Patients were treated by wide local excision. Clinically negative regional nodes were either followed up (n=42) or staged with sentinel lymph node biopsy (n=21), and clinically positive nodes underwent lymph node dissection (n=32).
  
  
  RESULTS
  Median follow-up was 65 months. A total of 45 (47%) patients relapsed, with 80% of the recurrences occurring within 2 years and 96% within 5 years. The 5-year crude cumulative incidence (CCI) of recurrence and disease-specific survival (DSS) were 52% and 67%, respectively. CCI of local 5-year recurrence was 5% for the study cohort. Patients with MCC in the head and neck region had a 5-year local-recurrence CCI of 19%, and patients with MCC in the extremity and trunk region had a 5-year local-recurrence CCI of 2% (P=0.007). Comparing patients with <or=2 versus >2 metastatic lymph nodes, the 5-year regional-recurrence CCI was 0% versus 39% (P=0.004). The 5-year distant-recurrence CCI was higher in clinically node-positive patients compared with node-negative patients (37% versus 12%; P=0.005). Patients with MCC in the head and neck region experienced no distant recurrences, patients with MCC in the extremity and trunk region had a 5-year distant-recurrence CCI of 22%, and patients with occult primary had a 5-year distant-recurrence CCI of 49% (P=0.023). The 5-year DSS rate was 80% for pathologically node-negative patients.
  
  
  CONCLUSIONS
  The prognosis for surgically managed early-stage MCC is variable. Thus multidisciplinary tumor-board consultation is needed to optimize individual patient management.
authors.affiliation: Department of Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Via G. Venezian 1, Milan, Italy.
authors.forename: Emilio
authors.initials: E
authors.lastname: Bajetta
authors.forename: Luigi
authors.initials: L
authors.lastname: Celio
authors.forename: Marco
authors.initials: M
authors.lastname: Platania
authors.forename: Salvatore
authors.initials: S
authors.lastname: Lo Vullo
authors.forename: Roberto
authors.initials: R
authors.lastname: Patuzzo
authors.forename: Andrea
authors.initials: A
authors.lastname: Maurichi
authors.forename: Mario
authors.initials: M
authors.lastname: Santinami
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015266:Carcinoma, Merkel Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000556:secondary / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome