A Practical Update of Surgical Management of Merkel Cell Carcinoma of the Skin

Table 9

Updated treatment algorithm for Merkel cell carcinoma [13–15].

Stages I and II (localized disease)
(i) Wide local excision with SLNB. If SLN positive, complete; LN dissection if feasible. If not, nodal radiotherapy
(ii) Wide excision and prophylactic lymph node dissection
(iii) Wide excision of the primary tumor, alone or combined; with adjuvant radiotherapy
(iv) Mohs micrographic surgery can be used if feasible
(v) Excision followed by postoperative adjuvant radiotherapy; to primary ± nodal regions
Stage III (regional disease)
(i) Wide local excision plus LN dissection if feasible. If not,; radiation therapy to primary and nodal regions
(ii) Adjuvant chemotherapy is controversial but may be; considered in selected fit high-risk patients
Stage IV (distant disease)
(i) Palliative care with or without surgery, radiotherapy, and; chemotherapy

LN: lymph node; SLN: sentinel lymph node; SLNB: sentinel lymph node biopsy.