How would you approach a patient with metastatic Merkel cell carcinoma to the axillary/supraclavicular lymph nodes of unknown primary?

It's important to note that the first step is to thoroughly stage the patient - PET/CT (additional imaging as warranted) and a skin survey.

For a patient with a nodal-only disease, I would approach this as a potentially curative case. While it's possible that the risk of distant metastatic disease i...

Node dissection, postop RT, and adjuvant chemo.