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Management of Merkel Cell Carcinoma: The Roles of Lymphoscintigraphy, Sentinel Lymph Node Biopsy and Adjuvant Radiotherapy

¹ Sydney Melanoma Unit, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW 2050, Australia
² Department of Radiation Oncology, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW 2050, Australia
³ Department of Anatomical Pathology, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW 2050, Australia
⁴ Discipline of Pathology, The University of Sydney, Sydney, NSW 2006, Australia
⁵ Nuclear Medicine and Diagnostic Ultrasound, Royal Prince Alfred Hospital Medical Centre, Newtown, NSW 2042, Australia
⁶ Discipline of Medicine, The University of Sydney, Sydney, NSW 2006, Australia
⁷ Discipline of Surgery, The University of Sydney, Sydney, NSW 2006, Australia

Correspondence: Address correspondence and reprint requests to: John F. Thompson, MD; E-mail: john.thompson{at}smu.org.au

Background: Merkel cell carcinoma (MCC) is an uncommon, highly aggressive skin malignancy with a propensity to recur locally and regionally. However, its optimal treatment is uncertain. In this study, we aimed to assess the roles of lymphoscintigraphy and sentinel node (SN) biopsy, as well as radiotherapy, in the treatment of MCC.

Patients and Methods: A retrospective analysis of 17 patients diagnosed with MCC (median age 74 years) over a 7-year period (median follow-up 16 months) was performed.

Results: Of 11 patients. 3 had a positive SN biopsy and, despite adjuvant radiotherapy, 2 of these 3 developed regional lymph node (RLN) recurrence. Of the remaining 8 patients who had a negative SN biopsy, however, 5 also had RLN recurrences. There were 9 patients who received adjuvant radiotherapy (RT) to the primary site, with no in-field recurrences; and 8 who received RT to their RLN field, with only 2 developing regional nodal recurrences—both were SN biopsy positive. During the follow-up period, 2 patients died, only 1 due to MCC.

Conclusion: The results suggest that SN status may not be an accurate predictor of loco-regional recurrence in MCC. However, they strongly reinforce previous reports that radiotherapy, both locally and to regional nodes, provides effective infield disease control.

Key Words: Merkel cell carcinoma • Lymphoscintigraphy • Prognosis • Radiotherapy • Sentinel lymph node biopsy • Treatment