title: Patients with clinically node negative extremity Merkel cell carcinoma: The importance of identifying and treating patients with microscopic nodal metastases.
abstract: OBJECTIVE
  To review the management of patients with Merkel cell carcinoma (MCC) of the distal arm or leg.
  
  
  METHODS
  The files of 27 patients with clinically node-negative extremity-located MCC treated between 1993 and 2007 at Westmead Hospital, Sydney, were reviewed.
  
  
  RESULTS
  The median age was 79 (range 48-91 years); there were 16 women and 11 men. The median follow up was 36 months. Eighteen patients had a below knee primary and nine had a below elbow primary. None had previous treatment of draining nodes. Most (26/27) underwent excision and 10 of the 27 received adjuvant local radiotherapy. The median lesion size was 19 mm (range 10-30 mm). In total 55% relapsed with most occurrences in the ipsilateral nodes of the axilla or groin. Median time to relapse was 5.5 months. Overall survival at two and five years was 68% and 57%, respectively.
  
  
  CONCLUSIONS
  Patients with extremity MCC experience a high rate of nodal relapse. Recently published evidence supports a survival benefit to identifying patients with microscopic nodal metastases. As en bloc primary and nodal treatment is not possible, and elective nodal treatment is likely to over-treat many patients, sentinel lymph node biopsy is a useful adjunct to current investigations and should be recommended.
authors.affiliation: Department of Radiation Oncology, University of Sydney, Westmead Hospital, Sydney, New South Wales, Australia. michael.veness@swahs.health.nsw.gov.au
authors.forename: Michael
authors.initials: M
authors.lastname: Veness
authors.forename: Julie
authors.initials: J
authors.lastname: Howle
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015266:Carcinoma, Merkel Cell / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D035002:Lower Extremity / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D018714:Radiotherapy, Adjuvant; D012008:Recurrence; D012878:Skin Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D016019:Survival Analysis; D034941:Upper Extremity / Q000473:pathology; D014964:X-Ray Therapy