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Selective lymphadenectomy in patients with Merkel cell (cutaneous neuroendocrine) carcinoma

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Abstract

Background: Merkel cell carcinoma (MCC) is an aggressive cutaneous tumor with a propensity for local recurrence, regional and distant metastases. There are no well-defined prognostic factors that predict behavior of this tumor, nor are treatment guidelines well established.

Methods: Staging of patients with a new diagnosis of MCC was attempted using selective lymphadenectomy concurrent with primary excision. Preoperative and intraoperative mapping, excision, and thorough histologic evaluation of the first lymph node draining the tumor primary site [sentinel node] was performed. Patients with tumor metastasis in the sentinel node underwent complete resection of the remainder of the lymph node basin.

Results: Twelve patients underwent removal of 22 sentinel nodes. Two patients demonstrated metastatic disease in their sentinel lymph nodes, and complete dissection of the involved nodal basin revealed additional positive nodes. The node-negative patients received no further surgical therapy, with no evidence of recurrent local or regional disease at a maximum of 26 months follow-up (median 10.5 months).

Conclusions: While the data are preliminary and initial follow-up is limited, early results suggest that sentinel lymph node mapping and excision may be a useful adjunct in the treatment of MCC. This technique may identify a population of patients who would benefit from further surgical lymph node excision.

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Authors and Affiliations

  1. From the Department of Pathology, University of South Florida College of Medicine, USA

    Jane L. Messina MD

  2. the Department of Surgery, Division of Surgical Oncology, H. Lee Moffitt Cancer Center, University of South Florida College of Medicine, Tampa, Florida, USA

    Douglas S. Reintgen MD

  3. the Department of Surgery, Division of Plastic Surgery, H. Lee Moffitt Cancer Center, University of South Florida College of Medicine, Tampa, Florida, USA

    Carl W. Cruse MD & David P. Rappaport MD

  4. the Department of Radiology, H. Lee Moffitt Cancer Center, University of South Florida College of Medicine, Tampa, Florida, USA

    Claudia Berman MD

  5. the Department of Internal Medicine, Division of Dermatology and Cutaneous Surgery, Cutaneous Oncology Program, H. Lee Moffitt Cancer Center, University of South Florida College of Medicine, Tampa, Florida, USA

    Neil A. Fenske MD &  L. Frank Glass MD

Authors
  1. Jane L. Messina MD
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  2. Douglas S. Reintgen MD
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  3. Carl W. Cruse MD
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  4. David P. Rappaport MD
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  5. Claudia Berman MD
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  6. Neil A. Fenske MD
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  7. L. Frank Glass MD
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Messina, J.L., Reintgen, D.S., Cruse, C.W. et al. Selective lymphadenectomy in patients with Merkel cell (cutaneous neuroendocrine) carcinoma. Annals of Surgical Oncology 4, 389–395 (1997). https://doi.org/10.1007/BF02305551

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  • DOI: https://doi.org/10.1007/BF02305551

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