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Merkel Cell Carcinoma of the Head and Neck
Effect of Surgical Excision and Radiation on Recurrence and Survival
Ann M. Gillenwater, MD;
Amy C. Hessel, MD;
William H. Morrison, MD;
M. Andrew Burgess, MD;
Elvio G. Silva, MD;
Dianna Roberts, PhD;
Helmuth Goepfert, MD
Arch Otolaryngol Head Neck Surg. 2001;127:149-154.
Background Merkel cell carcinoma is a rare malignant neoplasm of the skin that
most often arises in the head and neck region. Despite the innocuous appearance
of the primary lesion, Merkel cell carcinoma often has an aggressive clinical
course with frequent locoregional recurrences and distant metastases. We evaluated
the association of the width of surgical margins and the use of postoperative
radiation therapy with locoregional control and survival rates.
Methods The medical records of 66 patients with head and neck Merkel cell carcinoma
seen between 1945 and 1995 were retrospectively reviewed. The Fisher exact
test was used to compare outcomes. Kaplan-Meier survival curves were constructed.
Results Eighteen patients for whom there was adequate information were divided
into the following groups according to the width of their surgical margins:
smaller than 1 cm, 1 to 2 cm, and larger than 2 cm. No statistical difference
in locoregional control or survival was found among these groups owing to
the small patient population. In contrast, a comparison of the patients who
did (n = 26) and did not (n = 34) receive postoperative radiation therapy
revealed a significant difference in local (3 [12%] vs 15 [44%], respectively; P<.01) and regional (7 [27%] vs 29 [85%], respectively; P<.01) recurrence rates. There was, however, no significant
difference in the disease-specific survival between these groups (P = .30). Distant disease developed in 36% of all patients regardless
of therapy.
Conclusions Any effect of the width of surgical margins on outcome was not detectable
in the small number of patients analyzed. The use of postoperative radiation
therapy was associated with a significant improvement in locoregional control.
There was no detectable influence of the type of initial therapy on the rates
of distant metastases or on survival. Future therapeutic innovations should
be directed toward controlling the development of distant metastases in patients
with Merkel cell carcinoma.
From the Departments of Head and Neck Surgery (Drs Gillenwater, Hessel,
Roberts, and Goepfert), Radiation Oncology (Dr Morrison), Medicine (Dr Burgess),
and Pathology (Dr Silva), University of Texas M. D. Anderson Cancer Center,
Houston.
Corresponding author and reprints: Ann M. Gillenwater, MD, Department
of Head and Neck Surgery, University of Texas M. D. Anderson Cancer Center,
Box 441, Houston, TX 77030.
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