The impact of surgical excision modalities of Merkel cell carcinoma of the head and neck on recurrence, survival, and quality of life: A systematic review.

INTRODUCTION

Standard treatment for locoregional (stages I-III) Merkel cell carcinoma (MCC) includes wide local excision (WLE) with lymph node management. However, the optimal surgical approach remains debated, especially in the head and neck, where extensive excision may impair function and aesthetics, affecting patients' health-related quality of life (HR-QoL), and delay postoperative radiotherapy (RT).

OBJECTIVE

This systematic review aimed to evaluate the impact of surgical excision modalities - including surgical margins, Mohs micrographic surgery (MMS), and histological resection status - on recurrence and survival outcomes in head and neck MCC (HN-MCC). Secondary objectives included assessing morbidity and HR-QoL.

MATERIALS AND

METHODS

A systematic search of Medline, Embase, and Web of Science identified studies on HN-MCC surgical treatments. Studies were categorized into a narrative review and an individual descriptive analysis of cases. Two independent reviewers performed study selection, data extraction, and risk-of-bias assessment.

RESULTS

A total of 43 studies were included: 9 cohort studies, 10 case series, and 24 case reports. No randomized clinical trials were found. No superior technique was identified between MMS and WLE. No studies showed a statistical link between surgical margin categories or histological resection status and local control or survival outcomes. None of the cohort and case series studies reported data on HR-QoL in patients with HN-MCC.

CONCLUSION

Significant heterogeneity in available data limits definitive recommendations on surgical approaches for HN-MCC.