Merkel cell carcinoma: the role of primary treatment with radiotherapy

The recommended management of localised Merkel cell carcinoma has been wide surgical excision, combined with adjuvant radiotherapy in selected cases. The risk of recurrent regional disease is reported to be between 30% and 45%. A patient with a Merkel cell tumour on the cheek is presented in this paper. The patient was treated exclusively with radiotherapy to a total dose of 40 Gy. The tumour regressed rapidly during the treatment and there were no signs of local recurrence. However, the patient died of metastatic disease 31 months after initial diagnosis. A review of the literature revealed an additional eight cases of localized disease who did not undergo complete surgical excision but were primarily treated with radiotherapy alone. Regional recurrence was not found in any of the cases. One of the patients died of metastatic disease. Together with the review of the literature the present case provides evidence of the radiosensitivity of the Merkel cell carcinoma of the skin. The available data suggest that radiotherapy may be valuable as the primary treatment of localized biopsy-verified disease.