Multimodality treatment of Merkel cell carcinoma: Case series and literature review of 1024 cases

Background: Merkel cell carcinoma (MCC) is an unusual and potentially aggre ssive cancer of the skin. There is no consensus regarding the optimal thera peutic approach, and the relative roles of surgery, radiotherapy, and chemo therapy still are controversial The aim of this study is to analyze the rol es of these therapeutic options. Methods: The medical records of 16 patients with a diagnosis of localized, primary MCC treated at the University of Alabama at Birmingham were reviewe d. An extensive review of the English-language literature also was performe d. The Kaplan-Meier method was used to develop the survival curves. Compari sons were made using Fisher's exact test. Significance was defined as P < . 05. Results: MCC presented primarily in Caucasians (98.3%) with a median age of 69 years. Immunosuppressive therapy appeared to play a role in the develop ment of this cancer. In the UAB experience, 3-year actuarial survival was 3 1%. The only factor significantly associated with overall survival was the stage of disease at presentation: median survivals were 97 vs. 15 months fo r stages I and II, respectively (log-rank, P = .02). From the literature re view, adjuvant radiotherapy was associated with a reduced risk of local rec urrence (P < .00001). Conclusions: MCC is an aggressive cancer, with a high tendency for local re currence and distant spread. Surgery and adjuvant radiotherapy appear to pr ovide optimal local control. The role of chemotherapy remains to be defined .