If small cell carcinoma was found in an axillary lymph node with an unknown primary, would you recommend axillary lymph node dissection prior to chemoradiation?

Just to be clear, is this a patient with lung cancer? I know this is posted in the thoracic section, and has been responded to by a thoracic specialist, but usually “small cell carcinoma” in axillary lymph nodes without disease (especially in the thorax) elsewhere is Merkel cell carcinoma (cutaneous neuroendocrine carcinoma). Certainly a more rare disease than lung cancer, but without evidence of thoracic disease, it might make more sense. Clinical history might help corroborate the diagnosis. 5...

I would not recommend axillary lymph node dissection for metastatic ancillary lymph node small cell carcinoma. Surgery has not been proven to improve OS for metastatic small cell lung cancer. In addition, it carries significant co-morbidities such as arm edema. I would recommend chemotherapy, followed by local radiotherapy or concurrent chemo-radiotherapy. I would consider 45 Gy in 30 fractions BID for concurrent chemo/radiotherapy, or 45 Gy in 15 fractions QD after chemo.