title: Treatment of Merkel cell carcinoma with radiotherapy and imiquimod (Aldara): a case report.
abstract: OBJECTIVE
  Merkel cell carcinoma (MCC) is a rare skin tumor occurring mostly in older people. Postoperative radiotherapy is strongly recommended to improve local control. A case of a MCC treated by radiotherapy associated with imiquimod (Aldara) is presented. A possible physiopathological rationale for this concomitant treatment is also given.
  
  
  METHODS
  We treated a diabetic 82-year-old man presenting with a MCC of the right zygomatic area. Despite surgery, postoperative ultrasonography showed a firm, painless residual mass of about 11 x 10 cm, fixed to the deep tissues. Parotid and zygomatic areas were treated along with the ipsilateral laterocervical lymph nodes. The total dose to the planning target volume was 50.4 Gy (1.8 Gy/day). Imiquimod was applied once a day to the zygomatic area with macroscopic infiltration and to the surrounding erythema.
  
  
  RESULTS
  During the combination treatment, the patient showed acute G3 skin toxicity (RTOG) and a scab that resolved after a 3-week interruption of the radiotherapy and imiquimod treatment. When the scab was removed, the underlying skin appeared completely re-epithelialized. Imiquimod was suspended and treatment was continued only with irradiation. During this second phase of the treatment, the patient developed G2 dermatitis and G2 stomatitis. Clinical and instrumental re-evaluation showed a complete response 7 months after the end of radiotherapy, with very good local tropism.
  
  
  CONCLUSIONS
  This case report suggests the possible effective use of immunomodulators, in this case imiquimod, combined with radiation therapy for cutaneous malignancies such as MCC. Skin tolerance should be an important issue to consider.
authors.affiliation: Radiotherapy Department, Catholic University of Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Balducci
authors.forename: Berardino
authors.initials: B
authors.lastname: De Bari
authors.forename: Stefania
authors.initials: S
authors.lastname: Manfrida
authors.forename: Giuseppe Roberto
authors.initials: GR
authors.lastname: D'Agostino
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Valentini
mesh_terms: D000369:Aged, 80 and over; D000634:Aminoquinolines / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D015266:Carcinoma, Merkel Cell / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D017024:Chemotherapy, Adjuvant; D006801:Humans; D000077271:Imiquimod; D008297:Male; D018714:Radiotherapy, Adjuvant; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D016896:Treatment Outcome
chemical_list: D000634:Aminoquinolines; D000970:Antineoplastic Agents; D000077271:Imiquimod