For an upper lip (near midline) Merkel cell carcinoma s/p wide local excision with negative SLNB and no adjuvant RT, with the recurrence to one side of the neck a year later, should the contralateral neck be included in the radiation field?

Our practice for metachronous isolated neck metastases one year or more after primary treatment is to treat only the involved neck with the rationale that there has been adequate time for the cancer to declare itself.

This presumes the contralateral neck is screened with US and PET-CT, and then woul...

Practice patterns have some heterogeneity here, to be fair.

Our group for an immunocompetent patient would typically favor neoadjuvant immunotherapy for a patient with macroscopic regional recurrence (ideally with a clip/marker placed beforehand), with ctDNA used along with cross-sectional imaging (i...

Nope. There is no joy in chasing these around. The next port of call could well be an out-of-field nodal recurrence or a DM. Incidentally, there is a disproportionately high incidence of non-regional nodal mets in MCC. We presented this at ASTRO ages ago, and Dr. Nghiem’s group published on it.