Patients with Merkel cell carcinoma see similar survival with wide local excision, Mohs

Key takeaways:

• Patients receiving wide local excision or Mohs micrographic surgery showed similar survival outcomes (HR = 1.04).
• Sentinel lymph node biopsies and post-operative radiation are recommended for better survival.

Wide local excision and Mohs micrographic surgery exhibited no difference in survival outcomes among patients with Merkel cell carcinoma, according to a study.

“Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine tumor with high mortality and recurrence rates,” Kevin J. Moore, MD, MPH, of the department of Massachusetts General Hospital and Harvard Medical School, and colleagues wrote.

“There [are] limited large-scale data comparing overall and disease specific survival for MCC by surgical approach,” the researchers continued.

Moore and colleagues compared the MCC-specific survival outcomes between patients with node-negative MCC treated with wide local excision (WLE) and Mohs micrographic surgery (MMS).

The SEER database was used to collect data on 2,359 patients.

Results showed that there was no significant difference in survival outcomes between patients treated with WLE or MMS (HR = 1.04; 95% CI, 0.88-1.22). The incidence of mortality for MCC after 5 years was 13.9% for WLE recipients and 13.5% for MMS recipients.

In contrast, factors that were attributed to worse survival were being aged older than 75 years (HR = 2.9; 95% CI, 2.56-3.28), male sex (HR = 1.51; 95% CI, 1.35-1.69) and lack of radiation treatment (HR = 1.13; 95% CI, 1.02-1.26).

In a subgroup analysis, the researchers also found that those who underwent sentinel lymph node biopsies experienced higher MCC-specific survival outcomes (subdistribution HR = 0.5; 95% CI, 0.35-0.7).

As a result, Moore and colleagues wrote that MMS should be considered for treatment as long as a sentinel lymph node biopsy precedes the operation. They also emphasized that dermatologists should continue to adhere to the established guidelines which maintain that post-operative radiation is vital.

“This study demonstrates no significant difference in overall or MCC-specific survival for WLE compared to MMS for primary cutaneous MCC, which is similar to other recent single-institution and multicenter studies,” the authors concluded.