Treatment of Stage I–III Merkel Cell Carcinoma with an Operable Primary Tumour
This protocol addresses the management of localised Merkel cell carcinoma (Stage I–III) where the primary tumour is surgically resectable and there are no distant metastases. The goal is to achieve local and regional disease control through a coordinated surgical and radiation strategy.
Clinical Scenario
The patient presents with Stage I–III Merkel cell carcinoma in which the primary lesion is operable. There is no evidence of distant spread. The treatment plan is designed for this localised setting and encompasses both the primary tumour site and the regional nodal basin.
Treatment Approach (Partial Overview)
Management centres on surgical excision of the primary tumour — with careful attention to resection margins — combined with sentinel lymph node biopsy of the primary drainage region, followed in most cases by adjuvant radiotherapy to the tumour bed. The exact margin requirements, radiation dosing, and the specific criteria determining whether adjuvant radiotherapy may be omitted are detailed in the full protocol.
Full regimen criteria, staging-specific recommendations, and decision thresholds are available in the complete structured protocol.
References
DOI: 10.1016/j.esmoop.2024.102977
- The mainstay of treatment for patients with localised MCC is wide local excision (WLE) followed by tumour bed radiotherapy (RT) and management of the nodal basin.
- After excisional biopsy, WLE with a margin of 1-2 cm is considered adequate; if a resection margin of 1-2 cm is not technically achievable, a narrower margin (0.5-1.0 cm) with adjuvant RT may also be acceptable.
- SLNB should be carried out during local surgical therapy of the primary tumour with special attention to drainage patterns.
- Adjuvant RT with 50-60 Gy to the tumour bed is recommended for tumours of 1 cm in diameter and/or with negative prognostic features (stage IB).
- In patients at very low risk of locoregional recurrence (stage IA), clinical observation may be an alternative but such a decision should only be made at referral centres.
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