Clinical Scenario

This protocol addresses patients with stage I–III Merkel cell carcinoma who have an operable primary tumour and no evidence of distant metastases.

Disease Context

The mainstay of treatment for patients with localised Merkel cell carcinoma is wide local excision followed by tumour bed radiotherapy and management of the nodal basin. Sentinel lymph node biopsy findings are central to subsequent clinical decision-making.

Treatment Approach

Adjuvant radiotherapy to the nodal region plays a key role after sentinel lymph node evaluation, with the extent of nodal involvement shaping the full approach. Clinical trial participation for systemic therapy is also part of the pathway.

Full sequencing, eligibility criteria, and complete recommendations are in the 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 a positive SLNB, adjuvant RT alone or in combination with CLND is recommended after an MDT discussion.
In clinically positive LNs, multiple nodal involvements or extra-nodal extension of the SLN, regional LN dissection with post-operative RT is recommended (or definitive RT in inoperable patients).
Adjuvant ChT is not recommended; patients should be considered for clinical trials with (neo)adjuvant systemic therapy of modern immunotherapies.

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Treatment of Stage I–III Merkel Cell Carcinoma with an Operable Primary Tumour

References