How would you approach an early inguinal recurrence after surgical resection of Merkel Cell carcinoma in the popliteal region?

I would make sure there is no distant metastases with a PET-CT. Would try to enroll this patient in a trial. Current approach if localized in surgery followed by radiation, but with availability of immunotherapy, I would recommend at least an adjuvant immunotherapy after surgery. No one knows if radiation is very helpful for long term prognosis.

Other option is to start on neoadjuvant immunotherapy, then proceed to resection after 3 to 6 cycles, or if complete response, then complete immunotherapy followed by observation. Best immunotherapy regimen, in my personal opinion, includes ipilimumab, but this will need to be tested in further studies.

Postop RT and Med Onc eval for adjuvant chemo.