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Uitentuis SE, Bambach C, Elshot YS, Limpens J, van Akkooi ACJ, Bekkenk MW. Merkel Cell Carcinoma, the Impact of Clinical Excision Margins and Mohs Micrographic Surgery on Recurrence and Survival: A Systematic Review. Dermatol Surg 2022; 48:387-394. [PMID: 35165221 DOI: 10.1097/dss.0000000000003402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND When treating Merkel cell carcinoma (MCC), the relation between wide local excision (WLE) margin and recurrence or survival is unclear. Mohs micrographic surgery (MMS) is an alternative surgical option for MCC, but it is unknown whether the local recurrence rate differs between MMS and WLE. OBJECTIVE To systematically assess the available literature to determine the recurrence and survival rates when treating MCC with MMS and different clinical excision margins. MATERIALS AND METHODS The MEDLINE, EMBASE, and CENTRAL databases were searched. Two independent reviewers selected studies that defined clear excision margins and either recurrence or survival. When possible, individual cases were extracted from case series and included in the analyses. Other studies were reviewed narratively. RESULTS Overall, 1108 studies were identified; of which, 19 case series (168 cases) and 12 cohort studies were eligible. None of the cohort studies showed significant differences in recurrence or survival for either excision margins or MMS. Equally, logistic and Cox regression analyses of the case series revealed no significant differences in recurrence or survival between different excision margins and MMS. CONCLUSION Synthesis of the available data does not indicate differences in recurrence and/or survival rates for MCC between different clinical excision margins and MMS.
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Affiliation(s)
- Sanne E Uitentuis
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Caroline Bambach
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Yannick S Elshot
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Dermatology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | | | - Alexander C J van Akkooi
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Marcel W Bekkenk
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Kadiri S, Aissa A, Berhili S, Khmou M, Elmajjaoui S, Kebdani T, El Khannoussi B, Elkacemi H, Benjaafar N. Merkel cell carcinoma occurring in a black woman: a case report. J Med Case Rep 2017; 11:25. [PMID: 28143624 PMCID: PMC5282901 DOI: 10.1186/s13256-016-1189-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 12/27/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Merkel cell carcinoma is a rare, very aggressive neuroectodermal tumor of the skin. It is typically located on sun-exposed skin and frequently found in white men aged between 70 and 80 years. CASE PRESENTATION We report a case of a 58-year-old black woman diagnosed with Merkel cell carcinoma of the posterior face of the right elbow. She had biopsy excision and was lost to follow-up. Four months later, she presented with recurrent disease on the inferior third of the right arm with three ipsilateral axillary lymph node metastases. Amputation of the right arm and ipsilateral axillary lymph node dissection were performed, followed by adjuvant radiotherapy. Six months later, the patient died as a result of respiratory failure caused by lung metastasis. To the best of our knowledge, no specific studies have been done comparing the course and the characteristics of Merkel cell carcinoma in white and black populations, and no similar case has been reported in the literature. CONCLUSIONS The Merkel cell carcinoma is very rare in black people. As described elsewhere in the literature, our patient had a poor outcome despite radical management. To date, to the best of our knowledge, there has been no comparison of the prognosis of this tumor in white and black populations.
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Affiliation(s)
- Selma Kadiri
- Department of Radiotherapy, National Institute of Oncology, Rabat, Morocco
| | - Abdellah Aissa
- Department of Radiotherapy, National Institute of Oncology, Rabat, Morocco
| | - Soufiane Berhili
- Department of Radiotherapy, National Institute of Oncology, Rabat, Morocco
| | - Mouna Khmou
- Department of Cytopathology, National Institute of Oncology, Rabat, Morocco
| | - Sanaa Elmajjaoui
- Department of Radiotherapy, National Institute of Oncology, Rabat, Morocco
| | - Tayeb Kebdani
- Department of Radiotherapy, National Institute of Oncology, Rabat, Morocco
| | | | - Hanan Elkacemi
- Department of Radiotherapy, National Institute of Oncology, Rabat, Morocco
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Management of Merkel Cell Carcinoma. CURRENT DERMATOLOGY REPORTS 2015. [DOI: 10.1007/s13671-015-0116-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Prewett S, Ajithkumar T. Merkel Cell Carcinoma: Current Management and Controversies. Clin Oncol (R Coll Radiol) 2015; 27:436-44. [DOI: 10.1016/j.clon.2015.04.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 04/21/2015] [Indexed: 01/10/2023]
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Zager JS, Rollison DE, Messina J. Prognostication in Merkel cell carcinoma. Expert Rev Anticancer Ther 2014; 11:665-7. [DOI: 10.1586/era.11.50] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Kachare SD, Wong JH, Vohra NA, Zervos EE, Fitzgerald TL. Sentinel Lymph Node Biopsy is Associated with Improved Survival in Merkel Cell Carcinoma. Ann Surg Oncol 2013; 21:1624-30. [DOI: 10.1245/s10434-013-3434-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Indexed: 11/18/2022]
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Becker JC, Assaf C, Vordermark D, Reske SN, Hense J, Dettenborn T, Seitz O, Grabbe S. Brief S2k guidelines--Merkel cell carcinoma. J Dtsch Dermatol Ges 2013; 11 Suppl 3:29-36, 31-8. [PMID: 23734895 DOI: 10.1111/ddg.12015_6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Jürgen C Becker
- Division of General Dermatology, Graz University Hospital, Graz, Austria.
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Ellis DL, Davis RS. Evidence-based management of primary and localized Merkel cell carcinoma: a review. Int J Dermatol 2013; 52:1248-58. [PMID: 23829441 DOI: 10.1111/ijd.12091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Merkel cell carcinoma is a rare and often lethal cutaneous neuroendocrine malignancy with a tendency for early and frequent locoregional and distant metastasis and relapses. It is a tumor of the elderly and immunosuppressed, which most often appears on sun-exposed areas of the body. There is growing interest in characterization of the disease and the best approach to its management. Despite the lack of prospective randomized clinical trials, treatment is evolving. OBJECTIVE To provide an updated review of the most current and relevant data concerning the surgical (± radiological) management of Merkel cell carcinoma, including the role of Mohs micrographic surgery. METHODS Using relevant MeSH terms, we performed a review of the literature on the above subjects from 1981 to 2011. RESULTS AND CONCLUSION For primary tumors without evidence of organ metastases, surgical excision should be the primary therapy. Owing to the high rate of local metastases, a safety margin of at least 2 cm should be considered. In situations where small, localized tumors and/or special locations necessitate a smaller safety margin, compensation by complete histological examination of the excision margins and perhaps adjuvant radiation therapy should be undertaken. The literature states that benefits of Mohs micrographic surgery (over wide local excision) include tissue conservation and identification of tumors that may require extremely wide excision margins. The majority of data to date supports the use of Mohs surgery in the treatment of Merkel cell carcinoma.
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Affiliation(s)
- Dana L Ellis
- Department of Dermatology, Tulane University School of Medicine, New Orleans, LA, USA
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Merkel cell carcinoma - description of five cases. Contemp Oncol (Pozn) 2013; 17:321-3. [PMID: 24596523 PMCID: PMC3934078 DOI: 10.5114/wo.2013.35286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 03/08/2012] [Accepted: 04/18/2012] [Indexed: 11/25/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare but very aggressive skin cancer that derives from neuroendocrine cells of the skin. Merkel cell carcinoma morbidity has been continuously increasing for the last few years. Increasing reported incidence of MCC is probably connected with increasing occurrence of this kind of malignancy or with development of histological and immunohistochemical methods of sample examinations which have allowed for more precise diagnosis of skin tumor that might have previously not been accurately recognized. Merkel cell carcinoma develops as nodules early recognized as basocellular carcinoma, squamous cell carcinoma, amelanotic melanoma or skin lymphoma. Merkel cell carcinoma can be morphologically similar to skin metastasis as well as mild changes such as lipoma, cysts, fibroma or vessel changes. Accurate diagnosis is very important because it determines successful management and risk of progression of disease. We describe 5 patients with MCC who underwent surgical excision and then, after estimation of stage of disease, complementary treatment. Our observations prove that every tumor with MCC should be cut out with wide margins and regional lymphadenectomy or sentinel node biopsy is compulsory. After cutting out MCC involved-field radiotherapy is necessary and improves prognosis. Presence of metastases in lymphatic nodes is an indication for complementary chemotherapy.
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Deneve JL, Messina JL, Marzban SS, Gonzalez RJ, Walls BM, Fisher KJ, Chen YA, Cruse CW, Sondak VK, Zager JS. Merkel cell carcinoma of unknown primary origin. Ann Surg Oncol 2012; 19:2360-6. [PMID: 22271206 DOI: 10.1245/s10434-011-2213-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a rare neuroendocrine tumor of the skin. MCC from an unknown primary origin (MCCUP) can present a diagnostic and therapeutic challenge. We describe our single-institution experience with the diagnosis and management of MCCUP presenting as metastases to lymph nodes. METHODS After institutional review board approval, our institutional database spanning the years 1998-2010 was queried for patients with MCCUP. Clinicopathologic variables and outcomes were assessed. RESULTS From a database of 321 patients with MCC, 38 (12%) were identified as having nodal MCCUP. Median age was 67 years, and 79% were men. Nodal basins involved at presentation were cervical (58%), axillary/epitrochlear (21%), or inguinal/iliac (21%). CK20 staining was positive in 93% of tumors tested, and all were negative for thyroid transcription factor-1. Twenty-nine patients (76%) underwent complete regional lymph node dissection (LND): 3 had LND alone, ten had LND and adjuvant radiotherapy, and 16 underwent LND followed by chemoradiotherapy. Definitive chemoradiotherapy without surgery was provided to six patients (16%), while radiotherapy alone was provided to three (8%). Recurrence was observed in 34% of patients. Median recurrence-free survival was 35 months. Ten patients (26%) died, five of disease and five of other causes. The median overall survival was 104 months. CONCLUSIONS Nodal MCCUP is a rare disease affecting primarily elderly white men. Recurrence is observed in approximately one-third of patients, with a 104 month median overall survival after a multimodal treatment approach consisting of surgery along with adjuvant chemotherapy and radiotherapy in the majority of patients.
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Affiliation(s)
- Jeremiah L Deneve
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
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Fields RC, Busam KJ, Chou JF, Panageas KS, Pulitzer MP, Allen PJ, Kraus DH, Brady MS, Coit DG. Recurrence after complete resection and selective use of adjuvant therapy for stage I through III Merkel cell carcinoma. Cancer 2011; 118:3311-20. [PMID: 22072529 DOI: 10.1002/cncr.26626] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Revised: 08/29/2011] [Accepted: 08/29/2011] [Indexed: 11/12/2022]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a rare cutaneous neuroendocrine neoplasm whose natural history is poorly understood. Here, the authors describe their experience with a large cohort of patients who were treated at a single institution to describe patterns of recurrence after curative therapy. METHODS Review of a prospective database was performed. Patient-related, tumor-related, and treatment-related variables were recorded, and the site and timing of initial recurrence were recorded. Factors associated with receipt of adjuvant therapy and recurrence were determined. RESULTS In total, 364 patients with stage I through III MCC who underwent complete resection were identified. Adjuvant local radiation therapy (RT), lymph node RT, and chemotherapy were received selectively by 23%, 23%, and 15% of patients, respectively. Factors associated with the receipt of adjuvant therapy included younger age, primary tumor features (larger size, lymphovascular invasion [LVI], positive margin excision), and increasing pathologic stage. With median follow-up of 3.6 years, 108 patients (30%) developed a recurrence, including 11 local recurrences (3%), 12 in-transit recurrences (3%), 43 lymph node recurrences (12%), and 42 distant recurrences (12%). Clinically involved lymph nodes, primary tumor LVI, and a history of leukemia/lymphoma were predictive of recurrence. The majority of recurrences (80%) occurred in patients who had clinically involved lymph nodes or patients who did not undergo pathologic lymph node evaluation. CONCLUSIONS A low recurrence rate in patients with clinically lymph node-negative MCC was achieved with adequate surgery (including sentinel lymph node biopsy) and the selective use of adjuvant RT for high-risk tumors. In contrast, patients with clinically lymph node-positive MCC had significantly higher rates of recurrence, especially distant recurrence. The authors concluded that contemporary natural history studies are critical in designing treatment pathways and clinical trials for MCC.
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Affiliation(s)
- Ryan C Fields
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA
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Duprat JP, Landman G, Salvajoli JV, Brechtbühl ER. A review of the epidemiology and treatment of Merkel cell carcinoma. Clinics (Sao Paulo) 2011; 66:1817-23. [PMID: 22012057 PMCID: PMC3180159 DOI: 10.1590/s1807-59322011001000023] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 05/30/2011] [Indexed: 01/07/2023] Open
Abstract
Merkel cell carcinoma is a very rare and aggressive neoplasm. Due to its rarity, therapeutic guidelines are not well established, especially for regionally advanced disease. Articles in English, French, Italian, Portuguese, and Spanish from the last 20 years were identified in MEDLINE and reviewed. The key word "Merkel" was used for the search, relevant articles were selected, and their references were examined. The most important articles related to epidemiology, genesis and treatment were reviewed. The incidence of Merkel cell carcinoma is increasing due to the advancing age of the population, higher rates of sun exposure and an increasing number of immunocompromised individuals. With regard to etiology, the recently described Merkel Cell polyomavirus is thought to play a role. Either local or regional surgical intervention remains the standard of care, but adjuvant radiotherapy or radiotherapy as a primary treatment have been discussed as reasonable therapeutic options. An update on this rare neoplasia is essential because of its increasing incidence and changing treatment options.
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