Erica S Tarabadkar1, Teresa Fu2, Kristina Lachance3, Daniel S Hippe4, Thomas Pulliam3, Hannah Thomas3, Janet Y Li5, Christopher W Lewis3, Coley Doolittle-Amieva3, David R Byrd6, Jeremy T Kampp3, Upendra Parvathaneni7, Paul Nghiem8. 1. Department of Medicine, Division of Dermatology, University of Washington, Seattle, Washington; Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia. 2. Department of Medicine, Division of Dermatology, University of Washington, Seattle, Washington; Palo Alto Medical Foundation, Palo Alto, California. 3. Department of Medicine, Division of Dermatology, University of Washington, Seattle, Washington. 4. Department of Radiology, University of Washington, Seattle, Washington. 5. Southeast Dermatology, Houston, Texas. 6. Department of Surgery, Division of Surgical Oncology, University of Washington, Seattle, Washington. 7. Department of Radiation Oncology, University of Washington, Seattle, Washington. 8. Department of Medicine, Division of Dermatology, University of Washington, Seattle, Washington. Electronic address: pnghiem@uw.edu.
Abstract
BACKGROUND: Merkel cell carcinoma (MCC) management typically includes surgery with or without adjuvant radiation therapy (aRT). Major challenges include determining surgical margin size and whether aRT is indicated. OBJECTIVE: To assess the association of aRT, surgical margin size, and MCC local recurrence. METHODS: Analysis of 188 MCC cases presenting without clinical nodal involvement. RESULTS: aRT-treated patients tended to have higher-risk tumors (larger diameter, positive microscopic margins, immunosuppression) yet had fewer local recurrences (LRs) than patients treated with surgery only (1% vs 15%; P = .001). For patients who underwent surgery alone, 7 of 35 (20%) treated with narrow margins (defined as ≤1.0 cm) developed LR, whereas 0 of 13 patients treated with surgical margins greater than 1.0 cm developed LR (P = .049). For aRT-treated patients, local control was excellent regardless of surgical margin size; only 1% experienced recurrence in each group (1 of 70 with narrow margins ≤1 cm and 1 of 70 with margins >1 cm; P = .56). LIMITATIONS: This was a retrospective study. CONCLUSIONS: Among patients treated with aRT, local control was superb even if significant risk factors were present and margins were narrow. We propose an algorithm for managing primary MCC that integrates risk factors and optimizes local control while minimizing morbidity.
BACKGROUND: Merkel cell carcinoma (MCC) management typically includes surgery with or without adjuvant radiation therapy (aRT). Major challenges include determining surgical margin size and whether aRT is indicated. OBJECTIVE: To assess the association of aRT, surgical margin size, and MCC local recurrence. METHODS: Analysis of 188 MCC cases presenting without clinical nodal involvement. RESULTS: aRT-treated patients tended to have higher-risk tumors (larger diameter, positive microscopic margins, immunosuppression) yet had fewer local recurrences (LRs) than patients treated with surgery only (1% vs 15%; P = .001). For patients who underwent surgery alone, 7 of 35 (20%) treated with narrow margins (defined as ≤1.0 cm) developed LR, whereas 0 of 13 patients treated with surgical margins greater than 1.0 cm developed LR (P = .049). For aRT-treated patients, local control was excellent regardless of surgical margin size; only 1% experienced recurrence in each group (1 of 70 with narrow margins ≤1 cm and 1 of 70 with margins >1 cm; P = .56). LIMITATIONS: This was a retrospective study. CONCLUSIONS: Among patients treated with aRT, local control was superb even if significant risk factors were present and margins were narrow. We propose an algorithm for managing primary MCC that integrates risk factors and optimizes local control while minimizing morbidity.
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