The Treatment of Advanced Merkel Cell Carcinoma

BACKGROUND. The optimal management of Merkel cell carcinoma has not been clearly defined. OBJECTIVE. To describe the treatment of eight patients who presented with Merkel cell carcinoma. METHODS. Eight patients with advanced locoregional Merkel cell carcinoma were seen in our institute over a 7-year period. Four patients were successfully treated by induction chemotherapy after excisional biopsy, followed by radiotherapy. Three patients died from widespread metastases and one from neutropenic sepsis induced by chemotherapy. RESULTS. These cases demonstrate the potential lethality and aggressive nature of this rare skin tumor despite its chemosensitive and radioresponsive character. In all four patients who are alive and disease-free, chemotherapy was given first and radiotherapy was given as consolidation. CONCLUSION. We suggest that a multimodality treatment approach-chemotherapy followed by radiotherapy-is indicated in patients with advanced Merkel cell carcinoma.