What is the optimal treatment for Merkel cell carcinoma?

Treatment is generally based on the stage of the disease. There are four major treatments for MCC: 1) surgical excision of the primary lesion, 2) lymph node surgery, 3) radiation therapy, and 4) chemotherapy. Each will be reviewed below in greater detail. Depending on how well a patient tolerates the treatments, surgery, radiation therapy and chemotherapy may be given at the same time or one after the other.

For all stages of MCC, excision of the primary lesion with a greater than or equal to 2 cm margin (wide surgical excision) is recommended, whenever possible. As discussed before, it is important for all patients with no obvious lymph node disease to also undergo sentinel lymph node biopsy at the time of wide surgical excision to determine the presence of microscopic disease. Removal of all lymph nodes in a draining lymph node basin (lymph node dissection) can be considered in stage II disease. Lymph node dissection, however, may have side-effects, such as limb swelling (lymphedema). It is also unclear if the combination of lymph node dissection and radiation therapy improves the chance of recovery compared with radiation therapy alone.

Oncologists typically recommend radiation therapy to the site of the primary lesion and to the draining lymph node basin in stage I and II disease. Chemotherapy should be reserved for patients with stage III disease. However the age of the patient will play a vital role on this decision

Metastatic disease should be treated with radiotherapy and/or chemotherapy. The purpose of treatment in stage III disease is palliative. Palliative therapy is given to relieve symptoms, such as pain, and to help patients live more comfortably.

It is important to emphasize that optimal care depends on many issues that are highly variable between patients. It is thus best to obtain care from a multi-disciplinary team of physicians with significant experience with this disease and who take into consideration many factors such as: overall health of the patient, immune suppression, node status, tumor size and location, age, and the patient's personal philosophy in making decisions affecting quality vs quantity of life.

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