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Cecelia E. Schmalbach, MD; Lori Lowe, MD; Theodoros N. Teknos, MD; Timothy M. Johnson, MD; Carol R. Bradford, MD

Arch Otolaryngol Head Neck Surg. 2005;131:610-614.

Objective  To determine (1) the reliability of sentinel lymph node (SLN) biopsy and (2) the need for cytokeratin 20 (CK-20) immunostaining in the staging of head and neck Merkel cell carcinoma (MCC).

Design  Retrospective cohort study (median follow-up of 34.5 months).

Setting  Tertiary care center.

Patients  Ten patients with head and neck MCC who underwent regional staging with SLN biopsy (SLNB) and CK-20 immunostaining.

Interventions  Sentinel lymph nodes were identified using preoperative lymphoscintigraphy, intraoperative gamma probe, and isosulfan blue dye. The SLNs were evaluated with hematoxylin-eosin and CK-20 immunostaining. Patients with negative SLNB results were followed up clinically.

Main Outcome Measures  Percentage of positive SLNs, regional recurrence in the setting of a negative finding from SLNB, and percentage of positive SLNs requiring CK-20 immunostaining for diagnosis of micrometastatic MCC.

Results  At least 1 SLN was identified in every patient. Of 24 nodes, 19 (79%) were from the neck region and 5 (21%) were from the parotid basin. Two of the 24 SLNs, in 2 (20%) of 10 patients, were positive for metastatic disease. Both positive SLNs appeared negative on hematoxylin-eosin–stained sections, but small foci of micrometastatic MCC were identified with CK-20 immunostaining. No cranial nerve complications occurred. Regional failure in the setting of a negative finding on SLNB was observed in 1 (12%) of 8 patients.

Conclusions  Biopsy of SLNs represents a safe and reliable technique for regional staging of MCC of the head and neck. It provides pathologists with a limited number of SLNs for focused analysis, which is imperative because hematoxylin-eosin immunostaining is often insufficient for identifying micrometastatic MCC. The use of anti–CK-20 antibody allows accurate identification of micrometastatic MCC.

Author Affiliations: Departments of Otolaryngology–Head and Neck Surgery (Drs Schmalbach, Teknos, Johnson, and Bradford), Dermatology (Drs Lowe and Johnson), and Pathology (Dr Lowe), University of Michigan, Ann Arbor.

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