Merkel Cell Carcinoma: Report of 19 Cases and Review of the Literature

K. L. Gale, P. B. Milsom and J. de Beer

Whangarei Base Hospital, Northland, New Zealand

Purpose

Merkel cell carcinoma (MCC) is an aggressive primary neuroendocrine tumour of the skin. It has a propensity for dermal-lymphatic invasion, and nodal and haematogenous spread. There is no concensus regarding management. The aim of this study is to describe a provincial hospital’s experience with merkel cell, and to analyse the role of therapeutic options based upon current literature.

Methodology

A retrospective study was undertaken using Northland Pathology database during Dec 2002–2006. Demographics, tumour morphology and behaviour together with treatment modalities were documented.

Results

There were nine males and 10 females with an average age of 71 years (40–94 yrs). In 13 cases the primary lesion was nodular (68%), presenting amongst various sites, mostly head/neck 37%, and lower limb 32%. Relevant associated comorbidities included; multiple SCCs (1), melanoma (1), immunosuppression (1), and CLL (1).

At presentation, nine patients (47%) had regional lymphadenopathy and six patients (55%) underwent RLND. Distant metastases occured in 31%* of patients within 21 months (1–58 months). Nine patients (50%) underwent radiotherapy, and four (29%) had chemotherapy. Six patients died of MCC and one from an unrelated cause.

The incidence of MCC in Northland seems to be the highest in published series, with 4.75 cases/yr, in comparison with Australian studies (up to 3.9/yr), UK studies (0.87/yr ) and USA studies (up to 4.1/yr).

Conclusion

MCC seems to be increasing in incidence in an aging population. Early surgical intervention, coupled with adjuvant radiotherapy may improve outcome. This aggressive tumour is likely to become more of a focus amongst the field of Plastic Surgery.

Abstract from publication as appears in 2007 Journal of Surgery. The Royal Australian and New Zealand College of Surgeons. Download abstracts here.