2008 Annual Meeting Abstracts
Merkel Cell Carcinoma: Evolution from Historical to Current Management Consensus
Bing Yi, MD, Ponnandai Somasundar, MD, James Koness, MD, N Joseph Espat, MD.
Roger Williams Medical Center, Providence, RI, USA.
Objective: Merkel Cell Carcinoma (MCC) is an uncommon, albeit aggressive cutaneous neuroendocrine malignancy. No prospective randomized data are presently available to define the validity of prognostic features or treatment outcomes for MCC. The present series represents a single institution MCC experience, describing the outcome and evolution of treatment paradigms into the current consensus.
Design: Retrospective review.
Setting: General community hospital.
Patients: The prospective database identified 17 patients.
Main Outcome Measure: Relapse-free survival (RFS) was analyzed relative to stage, treatment.
Results: The median FU was 36 months (5-123) for all patients. The median age was 76(63-91). Males comprised of 63%, with head & neck (56%), extremity (25%), trunk (19%). Survival was stage-specific, 60% of patients were stage I with 78% 3-year RFS. 33% of patients were stage II with a 20% of 3 year RFS. A single stage III patient survived 5 months. The diagnostic and treatment impact of sentinel lymph node biopsy (SLN) was analyzed. Prior to 2000, 6 cases were performed WITHOUT SLN, 2/6 (33%) incorrectly understaged the disease identified by subsequent procedure; both cases had poor outcome. After 2000, SLN was instituted, achieving 100 % (6/6) diagnostic accuracy for lymph node metastases; of these patients no future lymph node or distant relapse was observed at 54 months FU. 12.5% of patients received systemic chemotherapy, (stage II). EBRT was given to 60% of stage I and 80% of stage II patients.
Conclusions: The survival of Merkel cell carcinoma is stage-specific. SLN biopsy can be supported to improve staging accuracy and thus define prognostic survival for MCC. Lastly, this institutional series is in concordance with the current consensus on MCC management and outcome.