What is your approach to adjuvant treatment to the tumor bed and/or regional lymph nodes for an early stage Merkel cell carcinoma status-post WLE and sentinel lymph node biopsy?
If there is an operationally failed sentinel lymph node biopsy, do you always include RT to regional nodes?
Answer from: Radiation Oncologist at Academic Institution
Merkel cell carcinoma is almost always beyond what you think are the safe margins of resection. Regardless of the completeness of wide local excision I generally extend the postoperative field two or 3 cm beyond the theoretically clear margin, obviously staying off of critical structures such ...
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Answer from: Radiation Oncologist at Academic Institution
I agree with the general principles highlighted by @Carl R. Bogardus. The one caveat to add is that early stage (IA) MCC arising in the limbs and trunk could safely be managed with surgical monotherapy after obtaining clear margins and a negative sentinal node biopsy in a patient with an intact immu...
Answer from: Radiation Oncologist at Academic Institution
I agree with both comments above. In my approach to a patient with MCC, I consider a sentinel node biopsy to be mandatory - if thats not possible, then I would try to include the primary draining nodal basin if that can be identified, and where possible would treat the primary site and nodal b...