title: Merkel cell carcinoma: An algorithm for multidisciplinary management and decision-making.
abstract: Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine tumor of the skin. Therapeutic approach is often unclear, and considerable controversy exists regarding MCC pathogenesis and optimal management. Due to its rising incidence and poor prognosis, it is imperative to establish the optimal therapy for both the tumor and the lymph node basin, and for treatment to include sentinel node biopsy. Sentinel node biopsy is currently the most consistent predictor of survival for MCC patients, although there are conflicting views and a lack of awareness regarding node management. Tumor and node management involve different specialists, and their respective decisions and interventions are interrelated. No effective systemic treatment has been made available to date, and therefore patients continue to experience distant failure, often without local failure. This review aims to improve multidisciplinary decision-making by presenting scientific evidence of the contributions of each team member implicated in MCC management. Following this review of previously published research, the authors conclude that multidisciplinary team management is beneficial for care, and propose a multidisciplinary decision algorithm for managing this tumor.
authors.affiliation: Radiation Oncology, Fundación Jiménez Díaz, Avd. Reyes Católicos 2, 28040 Madrid, Spain. Electronic address: iprieto@fjd.es.
authors.forename: Isabel
authors.initials: I
authors.lastname: Prieto
authors.affiliation: Plastic Surgery, Fundación Jiménez Díaz, Avd. Reyes Católicos 2, 28040 Madrid, Spain. Electronic address: tperezdelaf@fjd.es.
authors.forename: Teresa
authors.initials: T
authors.lastname: Pérez de la Fuente
authors.affiliation: Dermathology Department, Príncipe de Asturias University Hospital, Carretera de AlcaláMeco s/n, 28805 Alcalá de Henares, Madrid, Spain. Electronic address: dra_medina@telefonica.net.
authors.forename: Susana
authors.initials: S
authors.lastname: Medina
authors.affiliation: Medical Oncologist, Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046 Madrid, Spain. Electronic address: castelobeatriz@gmail.com.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Castelo
authors.affiliation: Radiology, Fundación Jiménez Díaz, Avd. Reyes Católicos 2, 28040 Madrid, Spain. Electronic address: bsobrino@idcsalud.es.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Sobrino
authors.affiliation: Pathology, Fundación Jiménez Díaz, Avd. Reyes Católicos 2, 28040 Madrid, Spain. Electronic address: jrfortes@fjd.es.
authors.forename: Jose R
authors.initials: JR
authors.lastname: Fortes
authors.affiliation: Radiation Oncology, Fundación Jiménez Díaz, Avd. Reyes Católicos 2, 28040 Madrid, Spain. Electronic address: David.esteban@idcsalud.es.
authors.forename: David
authors.initials: D
authors.lastname: Esteban
authors.affiliation: Anesthesiology, Fundación Jiménez Díaz, Avd. Reyes Católicos 2, 28040 Madrid, Spain. Electronic address: fcassinello@idcsalud.es.
authors.forename: Fernando
authors.initials: F
authors.lastname: Cassinello
authors.affiliation: Nuclear Medicine, Hospital Rey Juan Carlos, Calle Gladiolo, s/n, 28933 Móstoles, Madrid, Spain. Electronic address: jover@hospitalreyjuancarlos.es.
authors.forename: Raquel
authors.initials: R
authors.lastname: Jover
authors.affiliation: Medical Oncologist, Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046 Madrid, Spain. Electronic address: nuria.rodriguez@salud.madrid.org.
authors.forename: Nuria
authors.initials: N
authors.lastname: Rodríguez
mesh_terms: D000465:Algorithms; D015266:Carcinoma, Merkel Cell / Q000628:therapy*; D003131:Combined Modality Therapy / Q000379:methods*; D003657:Decision Making; D006801:Humans; D033183:Interdisciplinary Communication; D008198:Lymph Nodes / Q000473:pathology; D018358:Neuroendocrine Tumors / Q000628:therapy; D010348:Patient Care Team; D021701:Sentinel Lymph Node Biopsy; D012867:Skin / Q000473:pathology; D012878:Skin Neoplasms / Q000628:therapy*; D016896:Treatment Outcome
keywords: Algorithm for treatment; Decision making; Merkel cell carcinoma; Multidisciplinar management