Merkel cell carcinoma -: a retrospective analysis of 17 cases

Objective To report clinical experience with the rare neuroendocrine Merkel cell carcinoma of the skin. Subjects and setting Seventeen patients with Merkel cell carcinoma of the skin treated at the Departments of Dermatology and ENT, Krankenhaus Dresden-Friedrichstadt, Dresden, Germany, during the years 1984-2000 were evaluated. Methods A retrospective analysis was performed. Age and sex distribution, clinical data and therapy were collected. Outcome measures including overall survival, tumour-free survival and relapse-free survival were determined. Results Six male and 11 female patients with an age range of 68-90 years (mean age 73.3 years) were identified. The primary tumour localization was head and neck region (n = 8), upper limbs (8), lower limbs (1). Twelve patients presented in tumour stage I, three in stage 11 and one in stage III. First line therapy was complete surgical excision with wide margins in 16 patients followed by loco-regional radiation in 12 of 16 cases. In 16 patients follow up data were available. After primary treatment complete response was achieved in 14 of 16 patients (87.5%), two patients had a partial response. The median of relapse-free survival was 44 weeks [mean standard deviation: (44 +/- 118) weeks]. The median of overall survival was 102 weeks [mean +/- standard deviation: (137 +/- 94) weeks]. Three patients with a PR after primary treatment had a median overall survival of only 48 weeks [mean standard deviation: (51 +/- 20) weeks]. Conclusions Primary surgical treatment with wide excision combined with radiotherapy seems to be a reasonable first-line treatment but prospective controlled multicentre trials are necessary for validation.