Merkel cell carcinoma arising in the head and neck: optimizing therapy

Area of Science:

• Dermatology
• Surgical Oncology
• Neuro-oncology

Background:

• Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine skin cancer.
• Limited case numbers hinder statistically significant treatment data.
• Head and neck MCC is often linked to sun exposure and actinic damage.

Purpose of the Study:

• To evaluate head and neck MCC cases at Naval Medical Center San Diego (NMCSD).
• To compare treatment regimens and outcomes with other institutions.
• To review literature for optimal treatment strategies.

Main Methods:

• Retrospective outcomes analysis of head and neck MCC cases at NMCSD (1988-1998).
• Data sourced from NMCSD Tumor Registry and clinic charts.
• Literature review of existing MCC treatment studies.

Main Results:

• Eight of nine patients underwent wide-local excision or Mohs microsurgery with clear margins.
• One patient had distant metastasis; two developed nodal involvement.
• Literature shows inconsistent optimal treatment regimens and no chemotherapy proven to improve survival.

Conclusions:

• Head and neck MCC requires multimodality therapy: surgery, radiation, and possibly chemotherapy.
• Achieving wide tumor-free margins is crucial but challenging in the head and neck.
• Multi-institutional studies are vital for optimizing MCC treatment due to its rarity.