A Case of Merkel Cell Carcinoma: Treated with Wide Excision and Adjuvant Radiotherapy: DISCUSSION part 2

10 Feb

Merkel cell carcinoma

Evaluation and management of lymph node metastasis should be performed in all patients with MCC, because lymph node metastasis develops in up to 75% of patients. But, Routine performance of elective lymph node dissection (ELND) is cur­rently considered controversial because of potential morbidity, without proven survival benefit. Many recent studies suggest that, as alternative method, sentinel lymph node (SLN) mapping and biopsy could improve the ability to detect subclinical nodal metastases, sparing those patients with negative nodes the morbidity of lymph node dissection. SLN mapping and biopsy could provide a more accurate prognostic information for patients. Sheela G et al. recently suggested that SLN biopsy should be routinely included in the evaluation of patients with MCC.

The addition of post-operative irradiation of 45 to 60 Gy to the primary site and draining lymph node basins for 4 to 6 weeks has been found to decrease local recurrence. In a series by Gillenwater et al., adjuvant radiotherapy reduced local recurrence rate from 59% to 27%. Vennes MJ et al. also reported the addition of adjuvant radiotherapy showed a significant benefit in median disease-free survival, although there remained no benefit in overall sur­vival.

In advanced cases with distant metastasis, chemo­therapy has been mainly used for palliative pur­poses. Because of morphologic and immunohisto- logic similarity of MCC to small cell lung cancer, chemotherapy regimens employed in small cell lung cancer may provide a useful guide. But the impact of chemotherapy on survival has not been deter­mined. buy kamagra tablets

In conclusion, MCC is a rare but aggressive carcinoma. There is ongoing debate regarding the optimal treatment of this disease. However, recent evidence suggests that patients treated with surgery and adjuvant locoregional radiotherapy experience a better disease-free survival compared with those treated with surgery alone. We consider these aggre­ssive treatments to have been beneficial for our patient. But, we think that regular follow-up and close observation for disease recurrence should be required for a longer period to confirm successful treatment.