Merkel cell carcinoma: Critical review with guidelines for multidisciplinary management

Authors

  • Christopher K. Bichakjian MD,

    Corresponding author
    1. Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan
    • Department of Dermatology, University of Michigan Health System, 1910 Taubman Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0314
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    • Fax: (734) 936-6395.

  • Lori Lowe MD,

    1. Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan
    2. Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan
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  • Christopher D. Lao MD, MPH,

    1. Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
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  • Howard M. Sandler MD,

    1. Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, Michigan
    2. Department of Urology, University of Michigan Health System, Ann Arbor, Michigan
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  • Carol R. Bradford MD,

    1. Department of Otolaryngology, University of Michigan Health System, Ann Arbor, Michigan
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  • Timothy M. Johnson MD,

    1. Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan
    2. Department of Otolaryngology, University of Michigan Health System, Ann Arbor, Michigan
    3. Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan
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  • Sandra L. Wong MD

    1. Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan
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Abstract

Merkel cell carcinoma (MCC) is a relatively rare cutaneous malignancy that occurs predominantly in the older white population. The incidence of MCC appears to have tripled during the past 20 years; an increase that is likely to continue because of the growing number of older Americans. The pathogenesis of MCC remains largely unknown. However, ultraviolet radiation and immunosuppression are likely to play a significant pathogenetic role. Many questions currently remain unanswered regarding the biologic behavior and optimal treatment of MCC. Large, prospective, randomized studies are not available and are unlikely to be performed because of the rarity of the disease. The objective of this review was to provide a comprehensive reference for MCC based on a critical evaluation of the current data. The authors investigated the importance of sentinel lymph node biopsy as a staging tool for MCC to assess the status of the regional lymph node basin and to determine the need for additional therapy to the lymph node basin. In an attempt to standardize prospective data collection with the intention to define prognostic indicators, the authors also present histopathologic profiles for primary MCC and sentinel lymph nodes. The controversies regarding the appropriate surgical approach to primary MCC, the use of adjuvant radiation therapy, and the effectiveness of adjuvant chemotherapy were examined critically. Finally, the authors have provided treatment guidelines based on the available evidence and their multidisciplinary experience. Cancer 2007. © 2007 American Cancer Society.

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