Abstract
Background. A 72-year-old man presented with a Merkel cell carcinoma (MCC) of the left cheek with concomitant nodal spread. A 61-year-old man presented with an MCC of the right thigh with rapid nodal recurrence.
Investigations. Skin biopsy samples proved the MCC nature of the neoplasm in both patients. Staging procedure included clinical and radiological investigations.
Diagnosis. Advanced stage II MCC.
Management. Neoadjuvant cisplatin, etoposide and cyclophosphamide (EPC) regimen led to local control in the first patient and allowed curative surgery associated with adjuvant radiation therapy. Complete remission was maintained for 32 months. The second patient was treated by surgery plus radiation therapy. Nodal and cutaneous recurrences were treated with a neoadjuvant EPC regimen leading to a 5-year complete remission.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Rent or buy this article
Prices vary by article type
from$1.95
to$39.95
Prices may be subject to local taxes which are calculated during checkout
References
Yeingpruksawan, A., Coit, D. G., Thaler, H. T., Urmacher, C. & Knapper, W. K. Merkel cell carcinoma. Prognosis and management. Arch. Surg. 126, 1514–1519 (1991).
Becker, J. C. et al. Merkel cell carcinoma: molecular pathogenesis, clinical features and therapy. J. Dtsch. Dermatol. Ges 6, 709–719 (2008).
Heath, M. et al. Clinical characteristics of Merkel cell carcinoma at diagnosis in 195 patients: the AEIOU features. J. Am. Acad. Dermatol. 58, 375–381 (2008).
Pectasides, D., Pectasides, M. & Economopoulos, T. Merkel cell carcinoma of the skin. Ann. Oncol. 17, 1489–1495 (2006).
Goessling, W., McKee, P. H. & Mayer, R. J. Merkel cell carcinoma. J. Clin. Oncol. 20, 588–598 (2002).
Medina-Franco, H. et al. Multimodality treatment of Merkel cell carcinoma: case series and literature review of 1,024 cases. Ann. Surg. Oncol. 8, 204–208 (2001).
McAfee, W. J. et al. Merkel cell carcinoma: treatment and outcomes. Cancer 104, 1761–1764 (2005).
Mojica, P., Smith, D. & Ellenhorn, J. D. Adjuvant radiation therapy is associated with improved survival in Merkel cell carcinoma of the skin. J. Clin. Oncol. 25, 1043–1047 (2007).
Warner, R. E. et al. Management of Merkel cell carcinoma: the roles of lymphoscintigraphy, sentinel lymph node biopsy and adjuvant radiotherapy. Ann. Surg. Oncol. 15, 2509–2518 (2008).
Gupta, S. G. et al. Sentinel lymph node biopsy for evaluation and treatment of patients with Merkel cell carcinoma: The Dana-Farber experience and meta-analysis of the literature. Arch. Dermatol. 142, 685–690 (2006).
Senchevkov, A., Barnes, S. A. & Moran, S. L. Predictors of survival and recurrence in the surgical treatment of Merkel cell carcinoma of the extremities. J. Surg. Oncol. 96, 229–234 (2007).
Morton, D. L. et al. Sentinel-node biopsy or nodal observation in melanoma. N. Engl. J. Med. 355, 1307–1317 (2006).
Lewis, K. G., Weinstock, M. A., Weaver, A. L. & Otley, C. C. Adjuvant local irradiation for Merkel cell carcinoma. Arch. Dermatol. 142, 693–700 (2006).
Voog, E., Biron, P., Martin, J. P. & Blay, J. Y. Chemotherapy for patients with locally advanced or metastatic Merkel cell carcinoma. Cancer 85, 2589–2595 (1999).
Poulsen, M., Rischin, D., Walpole, E., Harvey, J., Mackintosh, J. et al. High-risk Merkel cell carcinoma of the skin treated with synchronous carboplatin/etoposide and radiation: a Trans-Tasman Radiation Oncology Group study-TROG 96:07. J. Clin. Oncol. 21, 4371–4376 (2003).
Poulsen, M. G. et al. Does chemotherapy improve survival in high-risk stage I and II Merkel cell carcinoma of the skin? Int. J. Radiat. Oncol. Biol. Phys. 64, 114–119 (2006).
Garneski, K. M. & Nghiem, P. Merkel cell carcinoma adjuvant therapy: current data support radiation but not chemotherapy. J. Am. Acad. Dermatol. 57, 166–169 (2007).
Tai, P. T. et al. Chemotherapy in neuroendocrine/Merkel cell carcinoma of the skin: case series and review of 204 cases. J. Clin. Oncol. 18, 2493–2499 (2000).
Poulsen, M. et al. Weekly carboplatin reduces toxicity during synchronous chemoradiotherapy for Merkel cell carcinoma of skin. Int. J. Radiat. Oncol. Biol. Phys. 72, 1070–1074 (2008).
Moloney, F. J. et al. A population-based study of skin cancer incidence and prevalence in renal transplant recipients. Br. J. Dermatol. 154, 498–504 (2006).
Acknowledgements
D. Lie, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing financial interests.
Rights and permissions
About this article
Cite this article
Jouary, T., Lalanne, N., Siberchicot, F. et al. Neoadjuvant polychemotherapy in locally advanced Merkel cell carcinoma. Nat Rev Clin Oncol 6, 544–548 (2009). https://doi.org/10.1038/nrclinonc.2009.109
Issue Date:
DOI: https://doi.org/10.1038/nrclinonc.2009.109
This article is cited by
-
Neoadjuvant Therapy for Non-melanoma Skin Cancer: Updated Therapeutic Approaches for Basal, Squamous, and Merkel Cell Carcinoma
Current Treatment Options in Oncology (2021)
-
Immune Checkpoint Inhibitors and Beyond: An Overview of Immune-Based Therapies in Merkel Cell Carcinoma
American Journal of Clinical Dermatology (2019)
-
A case of long-term survival following hepatectomy for liver metastasis of Merkel cell carcinoma
Surgical Case Reports (2015)
-
Peptide receptor radionuclide therapy of Merkel cell carcinoma using 177lutetium-labeled somatostatin analogs in combination with radiosensitizing chemotherapy: a potential novel treatment based on molecular pathology
Annals of Nuclear Medicine (2012)
-
Merkel-Zell-Karzinom
Der Chirurg (2011)