Localized Merkel Cell Carcinoma with Inoperable Primary Tumour: What to Do When Surgery Is Not an Option

This protocol addresses localized Merkel cell carcinoma where the primary tumour cannot be surgically removed — either because the extent of disease makes it technically inoperable, or because the patient's significant comorbidity makes surgery unsafe — and there is no evidence of distant metastases.

Clinical Scenario

In some patients, surgical therapy is not feasible due to the extent of disease (technically inoperable) or the presence of significant comorbidity. With no distant metastases, the focus shifts to achieving durable local disease control while reassessing the patient's candidacy for further intervention over time.

Treatment Approach — Partial Overview

For patients in this situation, the protocol draws on either a radiation-based or an immunotherapy-based strategy — with the preferred approach depending on nodal status and individual patient factors. The full eligibility criteria, selection pathway, and decision algorithm are available in the complete protocol.

Instant Access to Structured Evidence-Based Regimens

References

In some patients, surgical therapy is not feasible due to the extent of disease (technically inoperable) or the presence of significant (co)morbidity.
When WLE is not feasible, definitive RT of the primary tumour is an alternative approach.
Since MCC is radiosensitive, RT as a single modality is an alternative to surgery in this group.
Independently, the European Consensus-based interdisciplinary guideline and NCCN guidelines propose doses of 60-66 Gy for definitive treatment of patients with grossly positive primary tumour resection margins and/or clinically evident lymphadenopathy.
Patients with N0 disease eligible for immunotherapy should be preferably considered for anti-PD-1 therapy and reassessed for response and suitability for surgery by an MDT.

DOI: 10.1016/j.esmoop.2024.102977

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