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Journal of the American Academy of Dermatology
Volume 68, n° 3
pages 425-432 (mars 2013)
Doi : 10.1016/j.jaad.2012.09.036
accepted : 14 September 2012
Original Articles

Prognostic factors in Merkel cell carcinoma: Analysis of 240 cases
 

Tina I. Tarantola, MD a, , Laura A. Vallow, MD d, Michele Y. Halyard, MD e, Roger H. Weenig, MD g, Karen E. Warschaw, MD f, Travis E. Grotz, MD b, James W. Jakub, MD b, Randall K. Roenigk, MD a, Jerry D. Brewer, MD a, Amy L. Weaver, MS c, Clark C. Otley, MD a
a Department of Dermatology, Mayo Clinic, Rochester, Minnesota 
b Department of Gastroenterologic and General Surgery, Mayo Clinic, Rochester, Minnesota 
c Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota 
d Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida 
e Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona 
f Department of Dermatology, Mayo Clinic, Scottsdale, Arizona 
g Department of Dermatology, University of Minnesota, Minneapolis, Minnesota 

Reprint requests: Tina I. Tarantola, MD, Skin Cancer Center of NW Florida, 540 Fontaine St, Pensacola, FL 32503.
Abstract
Background

Knowledge regarding behavior of and prognostic factors for Merkel cell carcinoma (MCC) is limited.

Objective

We sought to further understand the characteristics, behavior, prognostic factors, and optimal treatment of MCC.

Methods

A multicenter, retrospective, consecutive study of patients with known primary MCC was completed. Overall survival and survival free of locoregional recurrence were calculated and statistical analysis of characteristics and outcomes was performed.

Results

Among the 240 patients, the mean age at diagnosis was 70.1 years, 168 (70.0%) were male, and the majority was Caucasian. The most common location was head and neck (111, 46.3%). Immunosuppressed patients had significantly worse survival, with an overall 3-year survival of 43.4% compared with 68.1% in immunocompetent patients. In our study, patients with stage II disease had improved overall survival versus those with stage I disease, in a statistically significant manner. Patients with stage III disease had significantly worse survival compared with stage I and with stage II. Primary tumor size did not predict nodal involvement.

Conclusion

The data presented represent one of the largest series of primary MCC in the literature and confirm that MCC of all sizes has metastatic potential, supporting sentinel lymph node biopsy for all primary MCC. Because of the unpredictable natural history of MCC, we recommend individualization of care based on the details of each patient’s tumor and clinical presentation.

The full text of this article is available in PDF format.

Key words : Merkel cell carcinoma, neuroendocrine carcinoma, nonmelanoma skin cancer, primary neuroendocrine carcinoma of skin, prognosis, retrospective

Abbreviations used : AJCC, CI, ELND, HR, IQR, MCC, NCCN, SLNB, TLND, XRT



 Funding sources: None.
 Conflicts of interest: None declared.



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