Merkel cell carcinoma of the head and neck - Effect of surgical excision and radiation on recurrence and survival

Background: Merkel cell carcinoma is a rare malignant neoplasm of the skin that most often arises in the head and neck region. Despite the innocuous a ppearance of the primary lesion, Merkel cell carcinoma often has an aggress ive clinical course with frequent locoregional recurrences and distant meta stases. We evaluated the association of the width of surgical margins and t he use of postoperative radiation therapy with locoregional control and sur vival rates. Methods: The medical records of 66 patients with head and neck Merkel cell carcinoma seen between 1945 and 1995 were retrospectively reviewed. The Fis her exact test was used to compare outcomes. Kaplan-Meier survival curves w ere constructed. Results: Eighteen patients for whom there was adequate information were div ided into the following groups according to the width of their surgical mar gins: smaller than 1 cm, 1 to 2 cm, and larger than 2 cm. No statistical di fference in locoregional control or survival was found among these groups o wing to the small patient population. In contrast, a comparison of the pati ents who did (n=26) and did not (n=34) receive postoperative radiation ther apy revealed a significant difference in local (3 [12%] vs 15 [44%], respec tively; P<.01) and regional (7 [27%] vs 29 [85%], respectively; P<.01) recu rrence rates. There was, however, no significant difference in the disease- specific survival between these groups (P=.30). Distant disease developed i n 36% of all patients regardless of therapy. Conclusions: Any effect of the width of surgical margins on outcome was not detectable in the small number of patients analyzed. The use of postoperat ive radiation therapy was associated with a significant improvement in loco regional control. There was no detectable influence of the type of initial therapy on the rates of distant metastases or on survival. Future therapeut ic innovations should be directed toward controlling the development of dis tant metastases in patients with Merkel cell carcinoma.