SELECTIVE LYMPHADENECTOMY IN PATIENTS WITH MERKEL CELL (CUTANEOUS NEUROENDOCRINE) CARCINOMA

Background: Merkel cell carcinoma (MCC) is an aggressive cutaneous tum or with a propensity for local recurrence, regional and distant metast ases. There are no well-defined prognostic factors that predict behavi or of this tumor, nor are treatment guidelines well established. Metho ds: Staging of patients with a new diagnosis of MCC was attempted usin g selective lymphadenectomy concurrent with primary excision. Preopera tive and intraoperative mapping, excision, and thorough histologic eva luation of the first lymph node draining the tumor primary site [senti nel node] was performed. Patients with tumor metastasis in the sentine l node underwent complete resection of the remainder of the lymph node basin. Results: Twelve patients underwent removal of 22 sentinel node s. Two patients demonstrated metastatic disease in their sentinel lymp h nodes, and complete dissection of the involved nodal basin revealed additional positive nodes. The node-negative patients received no furt her surgical therapy, with no evidence of recurrent local or regional disease at a maximum of 26 months follow-up (median 10.5 months). Conc lusions: While the data are preliminary and initial follow-up is limit ed, early results suggest that sentinel lymph node mapping and excisio n may be a useful adjunct in the treatment of MCC. This technique may identify a population of patients who would benefit from further surgi cal lymph node excision.