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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.

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