Current Problems in Cancer
Volume 34, Issue 1 , Pages 77-96 , January 2010

The Surgical Management of Primary and Metastatic Merkel Cell Carcinoma

  • Ricardo J. Gonzalez, MD

      Affiliations

    • Moffitt Cancer Center, Department of Cutaneous Oncology, Tampa, Florida, USA
    • Moffitt Cancer Center, Department of Sarcoma Oncology, Tampa, Florida, USA
    • ,
  • Tapan A. Padhya, MD

      Affiliations

    • University of South Florida, Department of Otolaryngology-Head and Neck Surgery, Tampa, Florida, USA
    • ,
  • Basil S. Cherpelis, MD

      Affiliations

    • University of South Florida, Department of Otolaryngology-Head and Neck Surgery, Tampa, Florida, USA
    • University of South Florida, Department of Dermatology, Tampa, Florida, USA
    • ,
  • Melanie D. Prince, MD

      Affiliations

    • University of South Florida, Division of Plastic Surgery, Department of Surgery, Tampa, Florida, USA
    • ,
  • Melanie L. Aya-ay, MD

      Affiliations

    • Moffitt Cancer Center, Department of Cutaneous Oncology, Tampa, Florida, USA
    • ,
  • Vernon K. Sondak, MD, FACS

      Affiliations

    • Moffitt Cancer Center, Department of Cutaneous Oncology, Tampa, Florida, USA
    • Moffitt Cancer Center, Department of Sarcoma Oncology, Tampa, Florida, USA
    • ,
  • C. Wayne Cruse, MD, FACS

      Affiliations

    • Moffitt Cancer Center, Department of Cutaneous Oncology, Tampa, Florida, USA
    • Moffitt Cancer Center, Department of Head and Neck Oncology, Tampa, Florida, USA
    • University of South Florida, Division of Plastic Surgery, Department of Surgery, Tampa, Florida, USA
    • ,
  • Jonathan S. Zager, MD, FACS

      Affiliations

    • Moffitt Cancer Center, Department of Cutaneous Oncology, Tampa, Florida, USA
    • Moffitt Cancer Center, Department of Sarcoma Oncology, Tampa, Florida, USA

References 

  1. Akhtar S, Oza KK, Wright J. Merkel cell carcinoma: report of 10 cases and review of the literature. J Am Acad Dermatol. 2000;43(5 Pt 1):755–767
  2. Medina-Franco H, Urist MM, Fiveash J, et al. Multimodality treatment of Merkel cell carcinoma: case series and literature review of 1024 cases. Ann Surg Oncol. 2001;8(3):204–208
  3. Agelli M, Clegg LX. Epidemiology of primary Merkel cell carcinoma in the United States. J Am Acad Dermatol. 2003;49(5):832–841
  4. Hodgson NC. Merkel cell carcinoma: changing incidence trends. J Surg Oncol. 2008;89(1):1–4
  5. Tai P. Merkel cell cancer: update on biology and treatment. Curr Opin Oncol. 2008;20(2):196–200
  6. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology, vol 1. 2008;
  7. Bichakjian CK, Lowe L, Loa CD, et al. Merkel cell carcinoma: critical review with guidelines for multidisciplinary management. Cancer. 2007;110(1):1–12
  8. Allen PJ, Bowne WB, Jacques DP, et al. Merkel cell carcinoma: prognosis and treatment of patients from a single institution. J Clin Oncol. 2005;23(10):2300–2309
  9. Allen PJ, Zhang ZF, Coit DG. Surgical management of Merkel cell carcinoma. Ann Surg. 1999;229(1):97–105
  10. Eng TY, Boersma MG, Fuller CD, et al. A comprehensive review of the treatment of Merkel cell carcinoma. Am J Clin Oncol. 2007;30(6):624–636
  11. Gillenwater AM, Hessel AC, Morrison WH, et al. Merkel cell carcinoma of the head and neck: effect of surgical excision and radiation on recurrence and survival. Arch Otolaryngol Head Neck Surg. 2001;127(2):149–154
  12. Eng TY, Naguib M, Fuller CD, et al. Treatment of recurrent Merkel cell carcinoma: an analysis of 46 cases. Am J Clin Oncol. 2004;27(6):576–583
  13. Stokes JB, Graw KS, Dengel LT, et al. Patients with Merkel cell carcinoma tumors ≤1.0 cm in diameter are unlikely to harbor regional lymph node metastasis. J Clin Oncol. 2009;27(23):3772–3777
  14. Bajetta E, Celio L, Platania M, et al. Single institution series of early stage Merkel cell carcinoma: long term outcomes in 95 patients managed with surgery alone. Ann Surg Oncol. 2009;16(11):2985–2993
  15. Jabbour J, Cumming R, Scolyer RA, et al. Merkel cell carcinoma: assessing the effect of wide local excision, lymph node dissection, and radiotherapy on recurrence and survival in early-stage disease—results from a review of 82 consecutive cases diagnosed between 1992 and 2004. Ann Surg Oncol. 2007;14(6):1943–1952
  16. Goepfert H, Remmler D, Silva E, et al. Merkel cell carcinoma (endocrine carcinoma of the skin) of the head and neck. Arch Otolaryngol. 1984;110(11):707–712
  17. Bielamowicz S, Smith D, Abemayor E. Merkel cell carcinoma: an aggressive skin neoplasm. Laryngoscope. 1994;104(5 Pt 1):528–532
  18. Azizi L, Marsot-Dupuch K, Bigel P, et al. Merkel cell carcinoma: a rare cause of hypervascular nasal tumor. AJNR Am J Neuroradiol. 2001;22(7):1389–1393
  19. Brissett AE, Olsen KD, Kasperbauer JL, et al. Merkel cell carcinoma of the head and neck: a retrospective case series. Head Neck. 2002;24(11):982–988
  20. Karapantzos I, Tsaroucha A, Polychronidis A, et al. Merkel cell carcinoma: report of seven cases. ORL J Otorhinolaryngol Relat Spec. 2003;65(6):370–374
  21. Suarez C, Rodrigo JP, Ferlito A, et al. Merkel cell carcinoma of the head and neck. Oral Oncol. 2004;40(8):773–779
  22. Veness MJ, Palme CE, Morgan GJ. Merkel cell carcinoma: a review of management. Curr Opin Otolaryngol Head Neck Surg. 2008;16(2):170–174
  23. Gillenwater AM, Hessel AC, Morrison WH, et al. Merkel cell carcinoma of the head and neck: effect of surgical excision and radiation on recurrence and survival. Arch Otolaryngol Head Neck Surg. 2001;127(2):149–154
  24. Lawenda BD, Thiringer JK, Foss RD, et al. Merkel cell carcinoma arising in the head and neck: optimizing therapy. Am J Clin Oncol. 2001;24(1):35–42
  25. Dancey AL, Rayatt SS, Soon C, et al. Merkel cell carcinoma: a report of 34 cases and literature review. J Plast Reconstr Aesthet Surg. 2006;59(12):1294–1299
  26. Boyer JD, Zitelli JA, Brodland DG, et al. Local control of primary Merkel cell carcinoma: review of 45 cases treated with Mohs micrographic surgery with and without adjuvant radiation. J Am Acad Dermatol. 2004;47(6):885–892
  27. Gollard R, Weber R, Kosty MP, et al. Merkel cell carcinoma: review of 22 cases with surgical, pathologic, and therapeutic considerations. Cancer. 2000;88(8):1842–1851
  28. O'Connor WJ, Roenigk RK, Brodland DG. Merkel cell carcinoma: comparison of Mohs micrographic surgery and wide excision in eighty six patients. Dermatol Surg. 1997;23(10):929–933
  29. McCarn KE, Park SS. Lip reconstruction. Otolaryngol Clin North Am. 2007;40(2):361–380
  30. Kokosuka ER, Kokoska MS, Collins BT, et al. Early aggressive treatment for Merkel cell carcinoma improves outcome. Am J Surg. 1997;174:688–693
  31. Mohs FE. Chemosurgery: a microscopically controlled method of cancer excision. Arch Surg. 1941;42:279–295
  32. Zitell JA, Brown C, Hanusa BH. Mohs micrographic surgery for the treatment of primary cutaneous melanoma. J Am Acad Dermatol. 1997;37(2, pt 1):236–245
  33. Clark GS, Pappas-Plitis EC, Cherpelis BS, et al. Surgical management of melanoma in situ on chronically sun-damaged skin. Cancer Control. 2008;15(3):216–224
  34. Shriner Dl, McCoy DK, Goldberg DG, et al. Mohs micrographic surgery. J Am Acad Dermatol. 1998;39(1):79–97
  35. Mehrany K, Otley CC, Weenig RH, et al. A meta-analysis of the prognostic significance of sentinel lymph node status in Merkel cell carcinoma. Dermatol Surg. 2002;28(2):113–117
  36. McAfee WJ, Morris CG, Mendenhall CM, et al. Merkel cell carcinoma: treatment and outcomes. Cancer. 2005;104(8):1761–1764
  37. Senchenkov A, Barnes SA, Moran SL. Predictors of survival and recurrence in the surgical treatment of Merkel cell carcinoma of the extremities. J Surg Oncol. 2007;95(3):229–234
  38. Messina JL, Reintgen DS, Cruse CW, et al. Selective lymphadenectomy in patients with Merkel cell (cutaneous neuroendocrine) carcinoma. Ann Surg Oncol. 1997;4(5):389–395
  39. Goessling W, McKee PH, Mayer RJ. Merkel cell carcinoma. J Clin Oncol. 2002;20(2):588–598
  40. Lewis JM, Zager JS, Yu D, et al. Full-thickness grafts procured from skin overlying the sentinel lymph node basin; reconstruction of primary cutaneous malignancy excision defects. Ann Surg Oncol. 2008;15(6):1733–1740
  41. Moncrieff MD, Bowen F, Thompson JF, et al. Keystone flap reconstruction of primary melanoma excision defects of the leg—the end of the skin graft?. Ann Surg Oncol. 2008;15(10):2867–2873
  42. Henness S, Vereecken P. Management of Merkel cell tumours: an evidence-based review. Curr Opin Oncol. 2008;20(3):280–286
  43. Gannon CJ, Rousseau DL, Ross MI, et al. Accuracy of lymphatic mapping and sentinel lymph node biopsy after previous wide local excision in patients with primary melanoma. Cancer. 2006;107(11):2647–2652
  44. Maza S, Trefzer U, Hofmann M, et al. Impact of sentinel lymph node biopsy in patients with Merkel cell carcinoma: results of a prospective study and review of the literature. Eur J Nucl Med Mol Imaging. 2006;33(4):433–440
  45. Hill AD, Brady MS, Coit DG. Intraoperative lymphatic mapping and sentinel lymph node biopsy for Merkel cell carcinoma. Br J Surg. 1999;86(4):518–521
  46. Morton DL, Thompson JF, Cochran AJ, et al. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med. 2006;355(13):1307–1317
  47. Warner RE, Quinn MJ, Hruby G, et al. Management of Merkel cell carcinoma: the roles of lymphoscintigraphy, sentinel lymph node biopsy and adjuvant radiotherapy. Ann Surg Oncol. 2008;15(9):2509–2518
  48. McMasters KM, Noyes RD, Reintgen DS, et al. Lessons learned from the Sunbelt Melanoma Trial. J Surg Oncol. 2004;86(4):212–223
  49. Conway WC, Faries MB, Nicholl MB, et al. Age-related lymphatic dysfunction in melanoma patients. Ann Surg Oncol. 2009;16(6):1548–1552
  50. Scoggins CR, Martin RC, Ross MI, et al. Factors associated with false-negative sentinel lymph node biopsy in melanoma patients: results from a prospective randomized trial. Ann Surg Oncol. 2009;16(Suppl 1):3
  51. Gupta SG, Wang LC, Penas PF, et al. Sentinel Lymph Node Biopsy for Evaluation and Treatment of Patients with Merkel Cell Carcinoma: the Dana-Farber experience and meta-analysis of the literature. Arch Dermatol. 2006;142(6):685–690
  52. Pectasides D, Pectasides M, Economopoulos T. Merkel cell cancer of the skin. Ann Oncol. 2006;17(10):1489–1495
  53. Sandel HD, Day T, Richardson MS, et al. Merkel cell carcinoma: does tumor size or depth of invasion correlate with recurrence, metastasis, or patient survival?. Laryngoscope. 2006;116(5):791–795
  54. Wagner JD, Evdokimow DZ, Weisberger E, et al. Sentinel node biopsy for high-risk nonmelanoma cutaneous malignancy. Arch Dermatol. 2004;140(1):75–79
  55. Sarnaik AA, Zager JS, Cox LE, et al. Routine omission of sentinel lymph node biopsy for Merkel cell carcinoma ≤1 cm is not justified. J Clin Oncol. 2010;28(1):e7

PII: S0147-0272(10)00020-6

doi: 10.1016/j.currproblcancer.2010.02.003

Current Problems in Cancer
Volume 34, Issue 1 , Pages 77-96 , January 2010

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