CLINICAL MANAGEMENT AND TREATMENT OUTCOMES OF MERKEL CELL-CARCINOMA

Background: Merkel cell carcinoma (MCC), first described in 1972, is a n uncommon, highly malignant tumour of skin. Its aetiology is unknown although the tumour occurs most frequently in sun-exposed sites. This skin cancer is characterized by a high incidence of metastases, local and regional recurrence and has a high mortality. Few survival data be yond 3 years are available. Treatment strategies include wide local ex cision of the primary and lymph node dissection, as indicated together with adjuvant radiotherapy. The tumour has also been shown to be chem osensitive. Definitive treatment is inconclusive due to the relative r arity of this malignancy. Methods: A retrospective study was undertake n between the years 1985 and 1996 of 33 patients with MCC at Concord R epatriation General Hospital (CRGH). Demographic details were noted, t ogether with the site and appearance of the primary lesion and the sit es and date of metastases. The response and outcome to various modalit ies of treatment were documented. Results: There were 27 men and six w omen with an average age of 80 years (range: 60-86 years). The primary lesion in the present series most often resembled a basal cell carcin oma (BCC), with 53% occurring in the head and neck region. Twenty-seve n patients (82%) developed metastastic disease, with an average interv al of 13.4 months between diagnosis of the primary lesion and the deve lopment of metastases. The incidence of locoregional recurrence in the present series was 42%. Radiation combined with surgery achieved loco regional control in 15 of 19 patients with primary, regional or recurr ent locoregional disease. Fourteen patients died of MCC and five other s from unrelated causes. The 14 survivors have a mean survival of 54 m onths with six patients surviving more than 5 years, Conclusions: Loca l excision together with regional lymph node clearance as indicated, c ombined with adjuvant radiation treatment was associated with an impro ved survival. The role of chemotherapy remains unclear.