Evidence and Considerations on Treatment of Small Size Merkel Cell Head and Neck Carcinoma

Abstract

Introduction Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine malignant cancer. It is an epidermal cancer common in the head and neck.

Objectives Though there is limited number of cases described in the literature for the treatment difficult to obtain. Our purpose was to present the clinical course and treatment of four patients with MCC.

Methods We conducted a retrospective analysis and obtained detailed clinical information for all 4 patients treated for MCC at the ENT Department of the SS Annunziata Hospital in Chieti, Italy, from 2013 through 2015.

Results In our study, two patients presented with the tumor in a rare site (lower eyelid). All of the patients underwent surgical treatment: three patients had free excision margins and negative sentinel lymph nodes (SLNs) while 1 patient had free excision margins and positive SLNs. The latter patient underwent ipsilateral neck dissection. In another patient, the fluorodeoxyglucose positron emission topography (FDG PET)/computed tomography (CT) performed 6 months after the surgery has shown high metabolic activity in the left parotid gland, and the patient underwent total parotidectomy and a neck dissection.

Conclusion Sentinel lymph node biopsy is a useful technique in small size MCCs of the head and neck. However, the parotid gland should be strictly controlled in patients with lower eyelid tumors.

Keywords

merkel cell carcinoma - merkel cell carcinoma treatment - neuroendocrine tumor - rare tumor - head and neck cancer

Publikationsverlauf

Eingereicht: 16. Dezember 2018

Angenommen: 26. Januar 2020

Artikel online veröffentlicht:
24. April 2020

• References

• 1 Schadendorf D, Lebbé C, Zur Hausen A. et al. Merkel cell carcinoma: Epidemiology, prognosis, therapy and unmet medical needs. Eur J Cancer 2017; 71: 53-69
• 2 van der Zwan JM, Trama A, Otter R. , et al; RARECARE WG. Rare neuroendocrine tumours: results of the surveillance of rare cancers in Europe project. Eur J Cancer 2013; 49 (11) 2565-2578
• 3 Fitzgerald TL, Dennis S, Kachare SD, Vohra NA, Wong JH, Zervos EE. Dramatic increase in the incidence and mortality from Merkel cell carcinoma in the United States. Am Surg 2015; 81 (08) 802-806
• 4 Youlden DR, Soyer HP, Youl PH, Fritschi L, Baade PD. Incidence and survival for Merkel cell carcinoma in Queensland, Australia, 1993-2010. JAMA Dermatol 2014; 150 (08) 864-872
• 5 Becker JC, Stang A, DeCaprio JA. et al. Merkel cell carcinoma. Nat Rev Dis Primers 2017; 3: 17077
• 6 Becker JC. Merkel cell carcinoma. Ann Oncol 2010; 21 (Suppl. 07) vii81-vii85
• 7 Lemos BD, Storer BE, Iyer JG. et al. Pathologic nodal evaluation improves prognostic accuracy in Merkel cell carcinoma: analysis of 5823 cases as the basis of the first consensus staging system. J Am Acad Dermatol 2010; 63 (05) 751-761
• 8 Feng H, Shuda M, Chang Y, Moore PS. Clonal integration of a polyomavirus in human Merkel cell carcinoma. Science 2008; 319 (5866): 1096-1100
• 9 Rollison DE, Giuliano AR, Becker JC. New virus associated with merkel cell carcinoma development. J Natl Compr Canc Netw 2010; 8 (08) 874-880
• 10 NCCN Guidelines Version 1.2018 Merkel Cell Carcinoma
• 11 Müller-Richter UDA, Gesierich A, Kübler AC, Hartmann S, Brands RC. Merkel Cell Carcinoma of the Head and Neck: Recommendations for Diagnostics and Treatment. Ann Surg Oncol 2017; 24 (11) 3430-3437
• 12 Filitis DC, Paragh G, Samie FH, Zeitouni NC. Sentinel lymph node biopsy in periocular merkel cell carcinoma: a case report. BMC Res Notes 2017; 10 (01) 490
• 13 Smith FO, Yue B, Marzban SS. et al. Both tumor depth and diameter are predictive of sentinel lymph node status and survival in Merkel cell carcinoma. Cancer 2015; 121 (18) 3252-3260
• 14 Kivelä T, Tarkkanen A. The Merkel cell and associated neoplasms in the eyelids and periocular region. Surv Ophthalmol 1990; 35 (03) 171-187
• 15 Iyer JG, Storer BE, Paulson KG. et al. Relationships among primary tumor size, number of involved nodes, and survival for 8044 cases of Merkel cell carcinoma. J Am Acad Dermatol 2014; 70 (04) 637-643
• 16 Schwartz JL, Griffith KA, Lowe L, Wong SL, McLean SA, Fullen DR. et al. Features predicting sentinel lymph node positivity in Merkel cell carcinoma. J Clin Oncol 2011; 29 (08) 1036-1041
• 17 Fields RC, Busam KJ, Chou JF. et al. Recurrence and survival in patients undergoing sentinel lymph node biopsy for merkel cell carcinoma: analysis of 153 patients from a single institution. Ann Surg Oncol 2011; 18 (09) 2529-2537
• 18 Deganello A, De Bree R, Dolivet G, Leemans CR. Infrahyoid myocutaneous flap reconstruction after wide local excision of a Merkel cell carcinoma. Acta Otorhinolaryngol Ital 2005; 25 (01) 50-53 , discussion 53–54
• 19 Mojica P, Smith D, Ellenhorn JD. Adjuvant radiation therapy is associated with improved survival in Merkel cell carcinoma of the skin. J Clin Oncol 2007; 25 (09) 1043-1047
• 20 Veness M, Howle J. Radiotherapy alone in patients with Merkel cell carcinoma: the Westmead Hospital experience of 41 patients. Australas J Dermatol 2015; 56 (01) 19-24
• 21 Takagishi SR, Marx TE, Lewis C. et al. Postoperative radiation therapy is associated with a reduced risk of local recurrence among low risk Merkel cell carcinomas of the head and neck. Adv Radiat Oncol 2016; 1 (04) 244-251