What are the therapeutic options for each stage of Merkel cell carcinoma (MCC)?

Updated: Jan 18, 2019
  • Author: Arjun S Joshi, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Stage I

Therapeutic options for stage I disease include surgical excision and radiation therapy. Adjuvant chemotherapy is generally used postoperatively, especially when wide surgical margins are unattainable or when the surgical margins were involved with tumor.

Stage II

Patients with clinical stage II disease present with clinically positive regional nodes. Fine-needle aspiration can be used to confirm regional metastatic spread. Most authorities recommend complete lymphadenectomy and postoperative radiation therapy given to the regional site.

Biopsy of any suggestive lesion at the primary site is performed to confirm local recurrence. If recurrence is present, treatment involves repeat excision with a 2-cm margin or with Mohs micrographic surgery. Administer additional radiation therapy if possible.

Biopsy of suggestive nodes is also done to confirm regional recurrence. If present, treatment includes repeat dissection of the lymph node basin and further radiation therapy, if possible. Adjuvant chemotherapy is used to manage regional recurrence.

Stage III

Distant metastatic disease (stage III) most often occurs in the lungs, liver, bone, or brain. The prognosis for patients with stage III disease is poor, with a mean survival time of 8 months.

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