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Surgical Management of Head and Neck Merkel Cell Carcinoma, are we doing Enough?

Fergal O’Duffy *,Tadhg O’Dwyer ,Samir Gendy

A case series and critical review of the current understanding and guidelines in management of Merkel cell carcinoma are presented. Merkel Cell Carcinoma of the head and neck is highly aggressive and has less predictable lymphatic drainage that that of the trunk and limbs. Variable surgical management strategies exist for the node negative neck including observation, radiation and prophylactic neck dissection. Current National Comprehensive Cancer Network Guidelines [NCCN] advocate radiation treatment and Sentinel Node Biopsy [SLNB] for the node negative neck. A potential pitfall of this management is the reduced accuracy of SLNB in the neck due to variable lymphatic drainage. Also the short to long term morbidity of irradiating the neck should not be underestimated. Merkel cell carcinoma is highly aggressive with micro metastasis reported at rates of 23% to 100%. In experienced surgical hands neck dissection in clinically node negative neck can provide excellent disease control with low morbidity and should be considered in the management of head and neck Merkel cell carcinoma.