title: Evolving paradigm in treatment of Merkel cell carcinoma of the digit from ray resection to wide local excision and flap coverage.
abstract: BACKGROUND
  Merkel cell carcinoma is a rare cutaneous neuroendocrine neoplasm that typically presents on the head and neck. Merkel cell carcinoma (MCC) of the digits is rare, and thus limited treatment options have been presented.
  
  
  METHODS
  In contrast to the current treatment recommendation of ray resection of the affected digit, two patients were treated by sentinel node biopsy, wide local excision, and flap coverage of the defect.
  
  
  RESULTS
  No local recurrences or metastases have been seen 24 months postoperatively.
  
  
  CONCLUSIONS
  We suggest that the paradigm of ray amputation of a digit affected by MCC should evolve to initial treatment with a sentinel lymph node biopsy (SLNB) with subsequent local excision with wide margins and local flap coverage.
authors.affiliation: School of Medicine, University of California, Irvine, 252 Irvine Hall, Irvine, CA 92697 USA.
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Doermann
authors.affiliation: Department of Surgical Oncology, University of California, Irvine, 101 The City Dr S, Orange, CA 92868 USA.
authors.forename: James
authors.initials: J
authors.lastname: G Jakowatz
authors.affiliation: Department of Orthopedic Surgery, University of California, Irvine, 101 The City Dr S, Orange, CA 92868 USA.
authors.forename: Neil
authors.initials: N
authors.lastname: F Jones
keywords: Digit; Hand; Merkel cell carcinoma; Treatment