Same-Day Coordination of Mohs Surgery, Lymphoscintigraphy, and Sentinel Lymph Node Biopsy for Merkel Cell Carcinoma: A Single-Center Feasibility Report.

Background/

Objectives

Merkel cell carcinoma (MCC) is an aggressive neuroendocrine tumor, most commonly occurring on the head and neck. Incidence of MCC is rising with the aging population. Five-year overall survival (OS) for localized MCC is 50.6%; 5-year OS for patients with distant metastases is 13.5%. The purpose of this study is to determine if coordination of care for the treatment of MCC is logistically feasible, and provide a description of the patient population observed at this institution.

Methods

All patients with MCC diagnosis from January 2012-June 2024 were identified at our tertiary care center. All patients with MCC were added to our non-melanoma skin cancer registry. Outcomes were compared between those treated with our "Merkel cell carcinoma in a day" (MIAD) protocol and those receiving the standard treatment protocol.

Results

No significant differences were detected in the recurrence rate, transit metastasis, distant metastasis, and disease-specific death. Nodal metastasis was higher in the MIAD group (HR 4.94, 95% CI 1.08-22.6, p = 0.039, six events total). Both groups had similar times to treatment and treatment within 30 days of diagnosis.

Conclusions

MCC is a rare and aggressive tumor, often exhibiting subclinical tumor spread. Mohs micrographic surgery ensures 100% peripheral and deep margin assessment, with potential for tissue sparing. With thoughtful coordination, lymphoscintigraphy can be completed on the same day as Mohs surgery followed by sentinel lymph node biopsy (SLNB) and reconstructive surgery.