Importance of Surgical Margins in Patients with Early-Stage Merkel Cell Carcinoma.

Publication Title

Dermatol Ther (Heidelb)

Authors

Arthur W Cowman, Providence Saint John's Cancer Institute, 2200 Santa Monica Blvd., Santa Monica, CA, 90404, USA.
Kristel Lourdault, Providence Saint John's Cancer Institute, 2200 Santa Monica Blvd., Santa Monica, CA, 90404, USA.Follow
Douglas Hanes, Department of Biostatistics, Providence St. Joseph Health, Portland, OR, USA.Follow
Sean Nassoiy, Providence Saint John's Cancer Institute, 2200 Santa Monica Blvd., Santa Monica, CA, 90404, USA.Follow
Paul Shin, Providence Saint John's Cancer Institute, 2200 Santa Monica Blvd., Santa Monica, CA, 90404, USA.Follow
Tyler Aguilar, Providence Saint John's Cancer Institute, 2200 Santa Monica Blvd., Santa Monica, CA, 90404, USA.Follow
Melanie Goldfarb, Providence Saint John's Cancer Institute, 2200 Santa Monica Blvd., Santa Monica, CA, 90404, USA.Follow
Richard Essner, Providence Saint John's Cancer Institute, 2200 Santa Monica Blvd., Santa Monica, CA, 90404, USA.Follow

Document Type

Article

Publication Date

3-1-2025

Keywords

Merkel cell carcinoma; NCDB; Negative surgical margins; Surgical margins; Survival; california; santa monica; oregon; portland

Abstract

INTRODUCTION: The National Comprehensive Cancer Network (NCCN) recommends excision of the primary tumor using 1-2-cm surgical margins and sentinel lymph node biopsy (SLNB) as the initial management of early-stage Merkel cell carcinoma (MCC). However, there is no clear consensus on the appropriate size of the surgical margins and/or the use of Mohs micrographic surgery (MMS). Our aim was to demonstrate that, independent of the type of surgery, obtaining negative surgical margins is associated with enhanced overall survival (OS).

METHODS: A retrospective study was performed using early-stage MCC patients from the National Cancer Database (NCDB) who were diagnosed between 2004 and 2020 and underwent surgical excision (SE) of their primary tumor. Patients were stratified into three groups based on the surgical treatment they received: < 1 cm excision margin, ≥ 1 cm excision margin, or MMS. OS was assessed with Kaplan-Meier curves, log-rank tests, and multivariable risk-adjusted Cox proportional-hazards regression.

RESULTS: Of the 4,607 patients included in this study; 53% underwent SE of ≥ 1 cm (n = 2,474), 41% had SE < 1 cm (n = 1,905), and the remainder had MMS (n = 228). 75% of patients had an SLNB, and 56% received adjuvant radiation to the primary site and/or nodal basin. While no difference in OS was observed between the three surgical treatments, negative surgical margins (hazard ratio (HR) 0.78; 95% confidence interval (CI) 0.65-0.94) and receipt of radiation to the primary site (HR 0.82; 95% CI 0.73-0.92) were both independently associated with improved OS.

CONCLUSION: Achieving negative surgical margins is associated with improved OS in MCC, suggesting that MMS and conventional excision are both suitable approaches for the treatment of primary MCC.

Area of Special Interest

Cancer

Specialty/Research Institute

Oncology

Specialty/Research Institute

Surgery

DOI

10.1007/s13555-025-01345-x