Would you recommend sentinel lymph node biopsy at the time of wide excision for a 3 mm Merkel cell carcinoma of the cheek/lateral canthus?

Unlike melanoma and certainly NMSC, MCC is highly unpredictable in nature, with clinical lesion size having little clinical prognostic value. As such, it appears that SLNB is valuable in many cases for the purposes of prognosis and in determining the need for adjuvant systemic therapy and radiation....

The size of the MCC lesion has been associated with an increased risk of occult nodal disease, though the numbers are typically greater than 1 cm in size, and not 3 mm (Han and St John, PMID 35394247; Gonzalez et al., PMID 36446191). In terms of irradiating a lesion close to the eye, if it's necessa...

I agree with the above that an SLNB would be wise (assuming the patient can tolerate it), as MCC can be unpredictable.

• Although the data on it is preliminary, when I worked in Seattle with the Merkel Group, we frequently offered patients a single fraction of 8 Gy in the postoperative setting (assumi...