The Australasian journal of dermatology · 2010
Patients with clinically node negative extremity Merkel cell carcinoma: The importance of identifying and treating patients with microscopic nodal metastases.
СтатьяНазвание и аннотация: Перевод в очереди
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Veness Michael, Howle Julie
Аннотация
OBJECTIVES: To review the management of patients with Merkel cell carcinoma (MCC) of the distal arm or leg.
METHODS: The files of 27 patients with clinically node-negative extremity-located MCC treated between 1993 and 2007 at Westmead Hospital, Sydney, were reviewed.
RESULTS: The median age was 79 (range 48-91 years); there were 16 women and 11 men. The median follow up was 36 months. Eighteen patients had a below knee primary and nine had a below elbow primary. None had previous treatment of draining nodes. Most (26/27) underwent excision and 10 of the 27 received adjuvant local radiotherapy. The median lesion size was 19 mm (range 10-30 mm). In total 55% relapsed with most occurrences in the ipsilateral nodes of the axilla or groin. Median time to relapse was 5.5 months. Overall survival at two and five years was 68% and 57%, respectively.
CONCLUSIONS: Patients with extremity MCC experience a high rate of nodal relapse. Recently published evidence supports a survival benefit to identifying patients with microscopic nodal metastases. As en bloc primary and nodal treatment is not possible, and elective nodal treatment is likely to over-treat many patients, sentinel lymph node biopsy is a useful adjunct to current investigations and should be recommended.
METHODS: The files of 27 patients with clinically node-negative extremity-located MCC treated between 1993 and 2007 at Westmead Hospital, Sydney, were reviewed.
RESULTS: The median age was 79 (range 48-91 years); there were 16 women and 11 men. The median follow up was 36 months. Eighteen patients had a below knee primary and nine had a below elbow primary. None had previous treatment of draining nodes. Most (26/27) underwent excision and 10 of the 27 received adjuvant local radiotherapy. The median lesion size was 19 mm (range 10-30 mm). In total 55% relapsed with most occurrences in the ipsilateral nodes of the axilla or groin. Median time to relapse was 5.5 months. Overall survival at two and five years was 68% and 57%, respectively.
CONCLUSIONS: Patients with extremity MCC experience a high rate of nodal relapse. Recently published evidence supports a survival benefit to identifying patients with microscopic nodal metastases. As en bloc primary and nodal treatment is not possible, and elective nodal treatment is likely to over-treat many patients, sentinel lymph node biopsy is a useful adjunct to current investigations and should be recommended.