Eighty-five percent of all Merkel cell carcinomas appear on sun-exposed areas, with 50% to 55% occurring on the head and neck.
A chart review was performed on 22 patients treated for Merkel cell carcinoma of the head and neck between 1981 and 1998.
Fifteen patients were men (68%). The average age at operation was 69.9 years (range, 24-84 years). The average duration of follow-up was 3.6 years (range, 3 days-8.6 years). Overall survival at 1, 2, and 3 years postoperatively was 78%, 68%, and 68%, respectively. The only independent predictor of survival was the type of surgical therapy. All patients who underwent wide local excision (WLE) of the primary tumor with dissection of the lymphatic drainage basin were alive at 2 years as opposed to 68% who had WLE alone and 33% who had Mohs surgery.
WLE and dissection of the lymphatic drainage basin provided the best overall survival.
"There is evidence supporting this surgical decision. Brissett et al.  display 2-year survival rates for a group of 22 patients who were treated for MCC by (a) wide local excision (WLE) only, (b) WLE and local lymphage drainage basin dissection, or (c) Mohs Surgery (chemosurgery). At a 2-year followup all patients in group (b) WLE plus lymphage dissection, were alive. "
[Show abstract][Hide abstract] ABSTRACT: . Merkel cell carcinoma of the head and neck is a rare and aggressive malignant tumour. Both the dermatological and surgical colleagues should be aware of this entity as lesions usually present on sun exposed areas of the skin such as the head and neck.
Main Observation and Treatment
. A 69-year-old male originally presented to the maxillofacial surgery department with a growing lesion on the left eyebrow. Histological analysis confirmed Merkel cell carcinoma and consequently surgical excision was carried out. A follow-up PET/CT scan 2 years later demonstrated a hotspot in the left parotid gland. Fine needle aspiration and cytology revealed Merkel cell carcinoma. A subtotal parotidectomy left side with ipsilateral selective neck dissection levels I to III was carried out.
. Potential secondary Merkel cell carcinoma in the head and neck region should be taken into account when planning short- and long-term follow up for previously diagnosed patients. This followup should involve both dermatological and surgical colleagues.
"Useful examples of surgical techniques can be found in the literature. In the retrospective study of 22 patients with head and neck MCC from Mayo clinic , all patients who underwent wide local excision of the primary tumor with dissection of the lymphatic drainage basin were alive at 2 years as opposed to 68% who had wide local excision alone and 33% who had Mohs surgery. Therefore, wide local excision and dissection of the lymphatic drainage basin provided the best overall survival. "
[Show abstract][Hide abstract] ABSTRACT: The role of surgeons in the treatment of Merkel cell carcinoma (MCC) of the skin is reviewed, with respect to diagnosis and treatment. Most of the data in the literature are case reports. Surgery is the mainstay of treatment. A wide local excision, with sentinel node (SLN) biopsy, is the recommended treatment of choice. If SLN is involved, nodal dissection should be performed; unless patient is unfit, then regional radiotherapy can be given. Surgeons should always refer patients for assessment of the need for adjuvant treatments. Adjuvant radiotherapy is well tolerated and effective to minimize recurrence. Adjuvant chemotherapy may be considered for selected node-positive patients, as per National Comprehensive Cancer Network guideline. Data are insufficient to assess whether adjuvant chemotherapy improves survival. Recurrent disease should be treated by complete surgical resection if possible, followed by radiotherapy and possibly chemotherapy. Generally results of multimodality treatment for recurrent disease are better than lesser treatments. Future research should focus on newer chemotherapy and molecular targeted agents in the adjuvant setting and for gross disease.
"We report here a single institution retrospective analysis. The demographics of our patient cohort differ from other retrospective reports, as do our survival rates [17, 48–51]. The mean age is slightly lower than in other larger reports  and we have a predominance of women and no immunosuppressed patients, which could be explained by our relatively small patient cohort. "
[Show abstract][Hide abstract] ABSTRACT: Merkel cell carcinoma (MCC) is a rare cutaneous malignancy occurring mostly in older immunocompromized Caucasian males. A growing incidence of MCC has been reported in epidemiological studies. Treatment of MCC usually consists of surgical excision, pathological lymph node evaluation, and adjuvant radiotherapy. This paper reports the experience of a single tertiary center institution with 17 head and neck Merkel cell carcinoma patients. Median followup for the cohort was 37.5 months. After five years, recurrence-free survival, disease specific survival, and overall survival were 85%, 90%, and 83%, respectively. Our limited data support the use of adjuvant radiotherapy. We also report two cases of MCC located at the vestibule of the nose and two cases of spontaneous regression after diagnostic biopsy. About 40% of our patients were referred to our center for surgical revision and pathological lymph node evaluation. Increased awareness of MCC and an interdisciplinary approach are essential in the management of MCC.
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