Sentinel-node guided lymph-node dissection for Merkel cell carcinoma

Merkel cell carcinoma is an aggressive neuroendocrine shin tumour. Treatmen t is still debatable. Merkel cell carcinoma resembles malignant melanoma in its cutaneous presentation and its embryonic origin; both have unpredictab le biological behaviour, early regional Lymph node involvement, early dista nt metastases and a high recurrence rate. In light of these common features , we used pre-operative lymphoscintigraphy, intraoperative lymph-node mappi ng and sentinel-node biopsy-a well-described technique for the treatment of melanoma-in a 60-year-old man with Merkel cell carcinoma in the right butt ock. Following frozen section identification of a metastatic first-order se ntinel node, radical right groin dissection was performed. All the other ly mph nodes in this basin proved to be disease-free, including the second-ord er sentinel node and Cloquet node. The patient is now being treated with ad juvant chemotherapy and radiotherapy. This case shows that sentinel-node guided dissection is applicable to Merke l cell carcinoma.