title: Merkel cell carcinoma in East Yorkshire: A case series and literature review of current management.
abstract: BACKGROUND
  Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine tumour of the skin. The incidence is rising and it is associated with sun exposure and immunosuppression. Our aim was to perform a 10-year retrospective review of MCC treated in East Yorkshire and to examine disease progression, surgical and adjuvant management, and outcomes.
  
  
  METHODS
  A 10-year retrospective review was undertaken of patients identified through the histopathology database. Case notes and digital patient records were examined for patient demographics, disease characteristics, management and outcome. Disease stage was calculated using the 2010 AJCC TNM classification.
  
  
  RESULTS
  Thirty-seven patients with complete records were included. Twenty-one patients were male and 16 female, with mean age 76.7 years at presentation. Pre-malignant or malignant skin changes were documented in 15 patients, and immunosuppression in 15 patients. Mean duration of lesion was 17.5 weeks. Following diagnosis 22/37 patients underwent further surgery with 11 patients undergoing sentinel lymph node (LN) biopsy. LN disease was palpable at presentation in 8 patients. Three year survival is 40%.
  
  
  CONCLUSIONS
  There is no standardised management of MCC and randomised trials are challenging due to relatively small numbers. There has been little progress made in terms of improving survival. Development of a national database for patients with this condition would allow prospective data collection and more accurate assessment of current treatment protocols and their efficacy.
  
  
  METHODS
  IV.
authors.affiliation: Department of Plastic Surgery, Leeds General Infirmary, Leeds, United Kingdom. Electronic address: pcjackson@doctors.org.uk.
authors.forename: Philippa C
authors.initials: PC
authors.lastname: Jackson
authors.affiliation: Department of Plastic Surgery, University Hospitals Coventry & Warwickshire, Coventry, United Kingdom.
authors.forename: Katy
authors.initials: K
authors.lastname: Wallis
authors.affiliation: Department of Statistics, Hull & York Medical School, Hull, United Kingdom.
authors.forename: Victoria
authors.initials: V
authors.lastname: Allgar
authors.affiliation: Department of Oncology, Castle Hill Hospital, Hull, United Kingdom.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lind
authors.affiliation: Department of Plastic Surgery, Castle Hill Hospital, Hull, United Kingdom.
authors.forename: Paul R W
authors.initials: PR
authors.lastname: Stanley
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D015266:Carcinoma, Merkel Cell / Q000453:epidemiology* / Q000473:pathology / Q000556:secondary / Q000628:therapy; D059186:Chemoradiotherapy, Adjuvant; D018450:Disease Progression; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D010166:Palliative Care; D011230:Precancerous Conditions / Q000453:epidemiology*; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D017678:Sex Distribution; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D015996:Survival Rate; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
keywords: Merkel cell carcinoma; Skin cancer; Treatment; Yorkshire