Locoregional Merkel cell carcinoma: Treatment of the primary tumor site

The management of the primary tumor site for locoregional MCC is presented here. Patients must have pathologically confirmed disease and no imaging/clinical evidence of distant metastatic disease prior to treatment. Staging evaluation of the locoregional lymph nodes must occur either prior to or in conjunction with treatment of the primary tumor (eg, wide local excision, Mohs micrographic surgery). For further details, refer to UpToDate content on staging evaluation, treatment, and surveillance of locoregional MCC.

RT: radiation therapy; MCC: Merkel cell carcinoma.

* For patients who are not anticipated to receive adjuvant RT (refer to inset), we suggest wide local excision with a surgical margin of at least 1 cm. For patients who are anticipated to receive adjuvant RT, we select a surgical margin size that offers complete or near-complete excision of disease, yet is conservative enough to avoid delays in wound healing and initiating RT. Mohs micrographic surgery can be used to treat primary MCC at sites where the cosmetic outcome is important, such as the face.

¶ For details on routine posttreatment surveillance, refer to UpToDate content on staging, treatment, and surveillance of locoregional MCC.

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Locoregional Merkel cell carcinoma: Treatment of the primary tumor site