Aim: To determine the long-term outcomes of early-stage Merkel cell carcinoma (MCC) patients managed with surgery alone. Methods: Ninety-five consecutive patients were reviewed. Patients were treated by wide local excision. Clinically negative regional nodes were either followed up (n = 42) or staged with sentinel lymph node biopsy (n = 21), and clinically positive nodes underwent lymph node dissection (n = 32). Results: Median follow-up was 65 months. A total of 45 (47%) patients relapsed, with 80% of the recurrences occurring within 2 years and 96% within 5 years. The 5-year crude cumulative incidence (CCI) of recurrence and disease-specific survival (DSS) were 52% and 67%, respectively. CCI of local 5-year recurrence was 5% for the study cohort. Patients with MCC in the head and neck region had a 5-year local-recurrence CCI of 19%, and patients with MCC in the extremity and trunk region had a 5-year local-recurrence CCI of 2% (P = 0.007). Comparing patients with ≤ 2 versus > 2 metastatic lymph nodes, the 5-year regional-recurrence CCI was 0% versus 39% (P = 0.004). The 5-year distant-recurrence CCI was higher in clinically node-positive patients compared with node-negative patients (37% versus 12%; P = 0.005). Patients with MCC in the head and neck region experienced no distant recurrences, patients with MCC in the extremity and trunk region had a 5-year distant-recurrence CCI of 22%, and patients with occult primary had a 5-year distant-recurrence CCI of 49% (P = 0.023). The 5-year DSS rate was 80% for pathologically node-negative patients. Conclusion: The prognosis for surgically managed early-stage MCC is variable. Thus multidisciplinary tumor-board consultation is needed to optimize individual patient management.
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