title: Management of early stage cutaneous Merkel cell carcinoma of the head and neck.
abstract: Merkel cell carcinoma (MCC) is a rare but aggressive skin cancer of neuroendocrine origin. As a result, few large studies have been published, and we know of even fewer on disease of the head and neck alone. The most appropriate way to manage patients with early local disease and no sign of metastases neck is controversial. We reviewed management of early cutaneous MCC of the head and neck in 8 hospitals in the United Kingdom over 12 years between 1999 and 2011 (the largest head and neck series in Europe to date), and identified 39 patients (19 men and 20 women) with early disease according to a well recognised classification. A total of 24 patients had stage Ia disease, 11 had stage Ib disease, and 4 were unclassified. Five of those with stage Ia disease developed regional metastases and 7 with stage Ib disease developed regional recurrence. The 2-year overall survival for stage Ia and Ib disease was 62% and 27%, respectively. Our study shows that prognosis is poor after conservative surgical management of stage I disease. Management of the neck is still controversial, and a meta-analysis of all the published data is needed to establish best practice statistically.
authors.affiliation: Oral and Maxillofacial Surgery Department, Queen Alexandra Hospital, Portsmouth PO16 3LY, UK. Electronic address: john.blythe1@nhs.net.
authors.forename: John N St J
authors.initials: JN
authors.lastname: Blythe
authors.affiliation: Oral and Maxillofacial Surgery Department, St. Richard's Hospital, Chichester PO19 6SE, UK.
authors.forename: David
authors.initials: D
authors.lastname: Macpherson
authors.affiliation: Oral and Maxillofacial Surgery Department, Queen Alexandra Hospital, Portsmouth PO16 3LY, UK.
authors.forename: William J
authors.initials: WJ
authors.lastname: Reuther
authors.affiliation: Oral and Maxillofacial Surgery Department, Southampton General Hospital, Southampton SO16 6YD, UK.
authors.forename: Madan
authors.initials: M
authors.lastname: Ethunandan
authors.affiliation: Oral and Maxillofacial Surgery Department, Poole Hospital, Poole BH15 2JB, UK.
authors.forename: Velupillai
authors.initials: V
authors.lastname: Ilankovan
authors.affiliation: Oral and Maxillofacial Surgery Department, Southampton General Hospital, Southampton SO16 6YD, UK.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Oral and Maxillofacial Surgery Department, Queen Alexandra Hospital, Portsmouth PO16 3LY, UK.
authors.forename: Rajiv A
authors.initials: RA
authors.lastname: Anand
authors.affiliation: Oral and Maxillofacial Surgery Department, Queen Alexandra Hospital, Portsmouth PO16 3LY, UK.
authors.forename: Timothy K
authors.initials: TK
authors.lastname: Mellor
authors.affiliation: Oral and Maxillofacial Surgery Department, The Royal Marsden Hospital, London SW3 6JJ, UK.
authors.forename: Cyrus
authors.initials: C
authors.lastname: Kerawala
authors.affiliation: Oral and Maxillofacial Surgery Department, Queen Alexandra Hospital, Portsmouth PO16 3LY, UK.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Brennan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015266:Carcinoma, Merkel Cell / Q000556:secondary / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Head and neck Merkel cell carcinoma; Merkel cell carcinoma