Lymphoscintigraphy with sentinel lymph node biopsy in cutaneous Merkel cell carcinoma

Merkel cell carcinoma (MCC) is a rare cutaneous malignancy characterized by an aggressive clinical behavior with high rates of locoregional and system ic recurrence. Regional disease and distant metastases are associated with poor prognosis. Despite a predisposition of MCC to spread via the lymphatic s, prophylactic lymph node dissection in the absence of clinically apparent lymph node involvement is controversial. The value of lymphoscintigraphy i n cutaneous melanoma is established in lesions with ambiguous lymphatic dra inage patterns. When used with sentinel lymph node biopsy (SLNB), it can id entify subjects with occult regional node metastasis. The authors present 2 patients with MCC who underwent regional node staging with lymphoscintigra phy-directed SLNB. Both patients had sentinel nodes that were positive for metastatic disease. In patients with MCC, minimally invasive regional node staging SLNB may be useful in limiting the sequelae of routine lymphadenect omies. Whether early identification and treatment of patients with occult r egional node disease can influence survival in MCC is not known.