RADIOTHERAPY FOR MERKEL-CELL-CARCINOMA OF THE SKIN OF THE HEAD AND NECK

Background. Merkel cell carcinoma is a relatively rare neuroendocrine carcinoma of the skin. It arises in the head and neck region in approx imately 50% of cases. Its aggressive behavior predisposes patients to local-regional recurrence and distant metastases after surgical excisi on alone. In this article, we describe our experience with Merkel cell carcinoma of the head and neck. Methods. Of 18 patients with Merkel c ell carcinoma treated in the Department of Radiation Oncology at the U niversity of Florida, 12 patients who had primary tumors in the head a nd neck region are reported. Eight patients were treated at initial di agnosis (group A), and four were treated at the time of local-regional recurrence (group B). Results. Local-regional control was achieved in seven of eight patients in group A and all four patients in group B. One patient in group A and all patients in group B developed distant m etastases and eventually died of their disease. Bone exposure develope d in one patient, requiring surgical debridement and hyperbaric oxygen treatment. Conclusion. Patients with Merkel cell carcinoma of the hea d and neck should be treated aggressively. Our data suggest that local -regional recurrence is a harbinger of distant metastases. We recommen d that these patients receive treatment to both the primary site and d raining lymphatics at initial presentation. The role of chemotherapy r emains unclear. (C) 1995 John Wiley and Sons, Inc.