Skin Cancer Research Today is a free monthly online journal that collates and summarizes the latest research about Skin Cancer, including details on identification, causes, prevention, treatment.

Merkel cell carcinoma: a review of management.

Veness MJ, Palme CE, Morgan GJ

Head and Neck Cancer Service, Westmead Hospital, University of Sydney, Sydney, Australia. michael.veness@swahs.health.nsw.gov.au

PURPOSE OF REVIEW: Merkel cell carcinoma is an uncommon but aggressive primary cutaneous neuroendocrine (small cell) carcinoma. The head and neck is a frequent site (50-60%) for presentation. The optimal treatment of patients with Merkel cell carcinoma remains debated with recent evidence adding support for a multimodality approach. Despite this the outcome for patients with unfavourable disease remains poor and in many series 25-50% of patients die as a direct result of Merkel cell carcinoma. RECENT FINDINGS: Wide excision (2-3 cm) of the primary lesion has been recommended, although achieving this is often impossible within the functional and cosmetic constraints of the head and neck. The well-documented responsiveness of this disease to radiotherapy and chemotherapy has strengthened the case for less radical surgery. Current best practice, as presented in recent publications, would support adjuvant wide-field radiotherapy, delivered after wide excision with negative microscopic margins, as best practice. The role of platinum-based chemotherapy remains under investigation. SUMMARY: Most patients with a Merkel cell carcinoma should be recommended wide-field adjuvant radiotherapy to encompass the primary site, in-transit tissue and first echelon lymph nodes following surgery. The benefit of adding chemotherapy is currently unproven and should be considered on an individual basis.

Published 10 March 2008 in Curr Opin Otolaryngol Head Neck Surg, 16(2): 170-4.
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