This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Allen, P. J. Articles by Coit, D. G. Search for Related Content PubMed PubMed Citation Articles by Allen, P. J. Articles by Coit, D. G. Pubmed/NCBI databases Medline Plus Health Information Skin Cancer Social Bookmarking                            What's this?

Merkel Cell Carcinoma: Prognosis and Treatment of Patients From a Single Institution

From the Departments of Surgery and Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY

Address reprint requests to Daniel G. Coit, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021; e-mail: coitd{at}mskcc.org

PURPOSE: Merkel cell carcinoma (MCC) is an uncommon cutaneous malignancy. Most reports consist of single-institution experiences of fewer than 30 patients. The natural history of MCC is poorly defined.

PATIENTS AND METHODS: A review was performed of Memorial Sloan-Kettering Cancer Center's MCC database, identifying 251 patients who had been treated between 1970 and 2002. Patient, tumor, and treatment-related factors were analyzed for their association with recurrence and survival.

RESULTS: The average follow-up for all patients was 40 months and 46 months for patients alive at last follow-up. The 5-year disease-specific survival rate was 64%. Disease stage was the only independent predictor of survival (stage I, 81%; stage II, 67%; stage III, 52%; stage IV, 11%; P = .001). Pathologic staging of the draining nodal basin was performed in 71 (40%) of 177 patients who presented with clinically negative nodes, and 16 of these patients (23%) were found to have node-positive disease. Pathologic nodal staging was associated with improved stage-specific survival probabilities (clinical node-negative, 75% v pathologic node-negative disease, 97%; P = .009) and decreased nodal recurrence (44% v 11%, P < .001). The median time to recurrence was 9 months, and 102 patients (43%) recurred. Local recurrence developed in 8% of patients after margin-negative excision.

CONCLUSION: These data demonstrate that the natural history of MCC is variable and dependent on the stage of disease at presentation. Pathologic nodal staging identifies a group of patients with excellent long-term survival. After margin-negative excision and pathologic nodal staging, local and nodal recurrence rates are low.

Supported by the Kristen Ann Carr Fund, New York, NY (P.J.A.).

This report contains original material and analysis not previously reported. Previous reports from our group regarding management of Merkel cell carcinoma include: Allen PJ, Zhang ZF, Coit DG: The surgical management of Merkel cell carcinoma. Ann Surg 229:97-105, 1999; and Yiengpruksawan A, Coit DG, Thaler HT, et al: Merkel cell carcinoma: Prognosis and management. Arch Surg 126:1514-1519, 1991.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				V. Koljonen, H. Kukko, E. Tukiainen, T. Bohling, R. Sankila, E. Pukkala, H. Sihto, H. Joensuu, L. Kyllonen, and H. Makisalo Incidence of Merkel cell carcinoma in renal transplant recipients Nephrol. Dial. Transplant., October 1, 2009; 24(10): 3231 - 3235. [Abstract] [Full Text] [PDF]

				M. Davids, A. Charlton, S.-S. Ng, M.-L. Chong, K. Laubscher, M. Dar, J. Hodge, R. Soong, and B. C. Goh Response to a Novel Multitargeted Tyrosine Kinase Inhibitor Pazopanib in Metastatic Merkel Cell Carcinoma J. Clin. Oncol., September 10, 2009; 27(26): e97 - e100. [Full Text] [PDF]

				The Rockville Merkel Cell Carcinoma Group Merkel Cell Carcinoma: Recent Progress and Current Priorities on Etiology, Pathogenesis, and Clinical Management J. Clin. Oncol., August 20, 2009; 27(24): 4021 - 4026. [Abstract] [Full Text] [PDF]

				J. B. Stokes, K. S. Graw, L. T. Dengel, B. R. Swenson, T. W. Bauer, C. L. Slingluff Jr, and E. J. Ledesma Patients With Merkel Cell Carcinoma Tumors <= 1.0 cm in Diameter Are Unlikely to Harbor Regional Lymph Node Metastasis J. Clin. Oncol., August 10, 2009; 27(23): 3772 - 3777. [Abstract] [Full Text] [PDF]

				H. Sihto, H. Kukko, V. Koljonen, R. Sankila, T. Bohling, and H. Joensuu Clinical Factors Associated With Merkel Cell Polyomavirus Infection in Merkel Cell Carcinoma J Natl Cancer Inst, July 1, 2009; 101(13): 938 - 945. [Abstract] [Full Text] [PDF]

				J. H. Ruan and M. Reeves A Merkel Cell Carcinoma Treatment Algorithm Arch Surg, June 1, 2009; 144(6): 582 - 585. [Abstract] [Full Text] [PDF]

				A Violaceous Nodule on the Knee--Diagnosis Arch Dermatol, June 1, 2009; 145(6): 715 - 720. [Full Text] [PDF]

				H. Zhang, G. Gupta, X. Y. Yang, R. Rosenbluth, and P. K Bhattacharyya A unique case of merkel cell carcinoma and chronic lymphocytic leukaemia presenting in a single cutaneous lesion (collision tumour) BMJ Case Reports, April 7, 2009; 2009(apr07_1): bcr0920081016 - bcr0920081016. [Abstract] [Full Text]

				B. D. Lemos, S. S. Yu, P. Nghiem, S. L. Wong, C. D. Lao, C. K. Bichakjian, P. M. Busse, and J. R. Clark Case 19-2008: Merkel-Cell Carcinoma N. Engl. J. Med., October 9, 2008; 359(15): 1629 - 1631. [Full Text] [PDF]

				J. A. Fiorillo Merkel Cell Carcinoma Metastatic to the Heart J. Clin. Oncol., July 20, 2008; 26(21): 3643 - 3644. [Full Text] [PDF]

				P. M. Busse, J. R. Clark, V. V. Muse, and V. Liu Case 19-2008 -- A 63-Year-Old HIV-Positive Man with Cutaneous Merkel-Cell Carcinoma N. Engl. J. Med., June 19, 2008; 358(25): 2717 - 2723. [Full Text] [PDF]

				D. M. Housman, R. H. Decker, and L. D. Wilson Regarding Adjuvant Radiation Therapy in Merkel Cell Carcinoma: Selection Bias and Its Affect on Overall Survival J. Clin. Oncol., October 1, 2007; 25(28): 4503 - 4504. [Full Text] [PDF]

				P. Mojica, D. Smith, and J. D.I. Ellenhorn In Reply J. Clin. Oncol., October 1, 2007; 25(28): 4504 - 4505. [Full Text] [PDF]

				E. J. Whitman, S. A. Brassell, I. L. Rosner, and J. T. Moncur Merkel Cell Carcinoma As a Solitary Metastasis to the Testis J. Clin. Oncol., August 20, 2007; 25(24): 3785 - 3786. [Full Text] [PDF]

				P. Mojica, D. Smith, and J. D.I. Ellenhorn Adjuvant Radiation Therapy Is Associated With Improved Survival in Merkel Cell Carcinoma of the Skin J. Clin. Oncol., March 20, 2007; 25(9): 1043 - 1047. [Abstract] [Full Text] [PDF]

				S. G. Gupta, L. C. Wang, P. F. Penas, M. Gellenthin, S. J. Lee, and P. Nghiem Sentinel Lymph Node Biopsy for Evaluation and Treatment of Patients With Merkel Cell Carcinoma: The Dana-Farber Experience and Meta-analysis of the Literature. Arch Dermatol, June 1, 2006; 142(6): 685 - 690. [Abstract] [Full Text] [PDF]

				M. Alam Management of merkel cell carcinoma: what we know. Arch Dermatol, June 1, 2006; 142(6): 771 - 774. [Full Text] [PDF]

				M. J. Veness Merkel Cell Carcinoma: Improved Outcome With the Addition of Adjuvant Therapy J. Clin. Oncol., October 1, 2005; 23(28): 7235 - 7236. [Full Text] [PDF]

				L. D. Wilson, D. Housman, and B. D. Smith Merkel Cell Carcinoma: Improved Outcome With the Addition of Adjuvant Therapy J. Clin. Oncol., October 1, 2005; 23(28): 7236 - 7237. [Full Text] [PDF]

				P. J. Allen, W. B. Bowne, D. P. Jaques, M. F. Brennan, K. J. Busam, and D. G. Coit In Reply: J. Clin. Oncol., October 1, 2005; 23(28): 7237 - 7238. [Full Text] [PDF]