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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

¹ Sydney Cancer Centre, Sydney, Australia
² School of Public Health, University of Sydney, Sydney, Australia
³ St. Vincent’s Hospital, Sydney, Australia
⁴ Concord Repatriation General Hospital, Hospital Road, Concord, NSW 2139, Australia
⁵ Centre for Research in Aging (CERA), Concord Repatriation General Hospital, Hospital Road, Concord, NSW 2139, Australia
⁶ Department of Anatomical Pathology, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia
⁷ Sydney Melanoma Unit, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia
⁸ Melanoma and Skin Cancer Research Institute (MASCRI), Sydney, Australia
⁹ Department of Radiation Oncology, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia
¹⁰ Department of Dermatology, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia
¹¹ Department of Dermatology, Concord Repatriation General Hospital, Hospital Road, Concord, NSW 2139, Australia

Correspondence: Address correspondence and reprint requests to: James Jabbour, BSc(Med), MBBS, MPH; 16 Kingsland Rd., Strathfield, New South Wales 2135, Australia; E-mail: j.jabbour{at}optusnet.com.au

Background: Wide surgical excision, lymph node dissection, and radiotherapy have been used with varying efficacy in the management of early-stage Merkel cell carcinoma.

Methods: Records of 82 patients with early-stage Merkel cell carcinoma between 1992 and 2004 were reviewed.

Results: Forty-two patients developed a recurrence, and 44 died during the study period. Twenty-nine patients presented with regional lymph node disease, which was independently associated with diminished survival (hazard ratio [HR], 4.08; 95% confidence interval [CI], 1.55–10.75; P = .005). Lymphadenectomy was independently associated with prolonged disease-free survival (median, 28.5 vs. 11.8 months; HR, .46; 95% CI, .22–.94; P = .034) but not overall survival (P = .25). Margin-negative excision of the primary tumor (60 of 73) was not significantly associated with either prolonged disease-free survival (median, 16 vs. 14 months) or overall survival (median, 54 vs. 34 months). Forty-eight patients received radiotherapy: 36 to the primary site and 31 to the regional lymph nodes. Radiotherapy to both sites was associated with a longer median time to first recurrence (primary site, 24.2 vs. 11.8 months; regional lymph nodes, 46.2 vs. 11.3 months) and survival (primary site, 53.9 vs. 45.7 months; regional lymph nodes, 103.1 vs. 34.2 months). Administration of any radiotherapy was significantly associated with a prolonged time to first recurrence (HR, .39; 95% CI, .20–.75; P = .004) and survival (HR, .39; 95% CI, .18–.82; P = .013) on the Cox regression multivariate analyses.

Conclusions: Adjuvant radiotherapy to the primary site after surgical excision is recommended in early-stage disease. Involved regional lymph nodes should be treated with radiotherapy with or without lymphadenectomy.

Key Words: Merkel • Radiotherapy • Margins • Survival • Recurrence • Prognosis

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