Background
Merkel cell carcinoma (MCC) is a rare and aggressive cutaneous neuroendocrine malignancy associated with high rates of recurrence and disease-specific mortality. Evidence guiding optimal management is limited due to its low incidence. Current consensus supports wide local excision with adjuvant radiotherapy (RT) for Stage I–III disease, reflecting the radiosensitive nature of MCC and its high propensity for locoregional recurrence. However, variability in management persists therefore this study aimed to evaluate treatment patterns and oncological outcomes of Stage I–III MCC at Dunedin hospital,New Zealand.
Methods
A retrospective audit was undertaken of patients diagnosed with Stage I–III MCC managed at Dunedin Hospital over a 10-year period. Patients were categorised according to treatment modality: surgery alone, surgery with adjuvant RT, or primary RT. Demographic, clinicopathological, margin status, treatment, recurrence, and follow-up variables were collected. The primary outcome was recurrence, including locoregional and distant disease.
Results
Preliminary result revealed twenty patients with Stage I–III MCC after exclusion of two patients with Stage IV disease. Median age at diagnosis was 85.5 years and 65% were male. Initial treatment comprised surgery with adjuvant RT in 13 patients (65%), RT alone in 4 (20%), and surgery alone in 3 (15%). Overall recurrence occurred in 10 patients (50%), including 4 locoregional recurrences (20%) and 6 distant metastases (30%). Seven patients (35%) had involved or close surgical margins; six proceeded to adjuvant RT without re-excision. Median follow-up was 31.9 months.
Conclusion
Multimodal therapy was commonly utilised; however recurrence remained frequent. Variation in management of positive margins was observed. These findings highlight the need for more standardised treatment pathways to optimise oncological outcomes in Stage I–III MCC.