Would you recommend adjuvant radiation therapy to the locoregional lymph node basins for Merkel cell carcinoma (MCC) with a solitary macroscopically positive lymph node (LN) without ECE after lymph node dissection?
As always the need to prophylacticaly treat possible residual nodal disease is influenced by many factors. Histology a key factor. Merkle cell is usually one step ahead of treatment. In this case I would definitely treat the nodes at risk. I would also treat widely around the resected primary skin site even with “clear” margins.
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Similar to melanoma, we have a higher threshold to treat nodes in the groin compared to H&N due to the higher lymphedema morbidity risk in the groin.
Following a comprehensive groin dissection, it is reasonable to watch the groin for a single small node positive MCC w/o ECE.
In the H&N, we offer PORT to all cases.
In our experience, even the best prognosis cases of T1N0 w/o any high risk factors have up to 26% local relapse rates if we omit RT.
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