Would you offer adjuvant radiation to the surgical bed for a Merkel cell carcinoma of the upper extremity with low-risk features as per the NCCN Guidelines?

There is no clear role for adjuvant RT here. This is a low risk situation and may be safely observed.

I would only consider it in this situation if the tumor was not widely excised (ie, an excisional biopsy was done for diagnostic purposes) and there was no plan for further surgery. The reported low rates of local recurrence with surgery alone (without adjuvant surgical bed radiation) have been afte...