Merkel cell primary sites impact survival
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DENVER — Survival of Merkel cell carcinoma can be impacted by primary tumor site, with head and neck tumors showing the highest rates of morbidity, according to a study presented here.
“Merkel cell carcinoma is a highly malignant and very rare malignancy,” Marcus L. Elias, MD, a dermatology resident at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, said during a presentation at the American Society for Dermatologic Surgery Annual Meeting. “Prior literature has shown a higher incidence in the head and neck region, but previous literature on the role of the primary site on survival is lacking.”
A retrospective cohort study of the National Cancer database identified 11,579 cases to review, which excluded cases for nonprimary malignancies, inadequate follow-up time and those receiving palliative care.
Approximately 40% (4,804) of the cases were head and neck primary cases, with approximately 20% being scalp and neck, according to Elias.
Researchers used Kaplan-Meier survival plots to do a univariate analysis and proportional hazard modeling to complete multivariable analysis to control for age, sex, race, comorbidities, insurance, stage, surgical margins, chemotherapy, radiation and location.
Overall survival rate was significantly lower at the 1-, 3- and 5-year marks compared with primary tumor sites on the body in both the univariate and multivariable analyses.
Specifically, scalp and neck primary tumors had significantly lower rates of survival compared with head and neck primaries.
A hazard ratio of 1.091 was found when comparing head and neck primaries with body primaries, whereas a hazard ratio of 1.297 was found when looking at scalp and neck primaries.
“Our data suggests a high incidence of Merkel cell on the head and neck and it suggests an increased risk of death in patients with head and neck — and in particular scalp and neck — primary lesions,” Elias said. “I know this carcinoma is rare, but with daily practice, I think the main takeaway is to expedite these patients with the proper treatment, imaging and subspecialty care, whether that means Mohs, radiation or oncology, so that we can best take care of these patients.”