Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Oct;25(11):3334-3340.
doi: 10.1245/s10434-018-6688-y. Epub 2018 Aug 2.

Resection Margins in Merkel Cell Carcinoma: Is a 1-cm Margin Wide Enough?

Matthew C Perez  1 , Felipe R de Pinho  2 , Amanda Holstein  1 , Daniel E Oliver  3 , Syeda M H Naqvi  4 , Youngchul Kim  4 , Jane L Messina  1 , Erin Burke  1 , Ricardo J Gonzalez  1 , Amod A Sarnaik  1 , C Wayne Cruse  1 , Evan J Wuthrick  3 , Louis B Harrison  3 , Vernon K Sondak  1 , Jonathan S Zager  5
Affiliations

Resection Margins in Merkel Cell Carcinoma: Is a 1-cm Margin Wide Enough?

Matthew C Perez et al. Ann Surg Oncol. 2018 Oct.

Abstract

Background: Guidelines regarding specific resection margins for primary Merkel cell carcinoma (MCC) are not well established. The current National Comprehensive Cancer Network (NCCN) guidelines recommend 1- to 2-cm resection margins. This study aimed to determine the impact of margin width on local recurrence (LR), disease-specific survival (DSS), overall survival (OS), and type of wound closure.

Methods: All patients who underwent resection of primary MCC at a single institution from 2000 to 2015 were reviewed. Patient demographics, clinicopathologic characteristics, treatments, and outcomes were reviewed.

Results: A total of 240 patients underwent resection of primary MCC with resection margin width identified in the operative report. The median age was 76 years, and 65.8% of the patients were men. Of the 240 patients, 85 (35.4%) had head and neck primaries, 140 (58.3%) had extremity primaries, and 15 (6.3%) had trunk primaries. In terms of margins, 69 patients (28.8%) had a margin of 1 cm, 36 patients (15%) had a margin of 1.1-1.9 cm, and 135 patients (56.2%) had a margin of 2 cm or more. The median follow-up period was 21 months. The LR rate was 2.9% for a margin of 1 cm, 2.8% for a margin of 1.1-1.9 cm, and 5.2% for a margin of 2 cm or more (p = 0.80). The 5-year OS was 63.6% for a margin of 1 cm, 59.7% for a margin of 1.1-1.9, and 70.7% for a margin of 2 cm or more (p = 0.66). The 5-year DSS was 80.3% for a margin of 1 cm, 66.2% for a margin of 1.1-1.9 cm, and 91.8% for a margin of 2 cm or more (p = 0.28). For wound closure, 43.5, 50, and 65.9% of the patients respectively required a flap or graft with a margin of 1, 1.1-1.9, and 2 cm or more (p = 0.006).

Conclusions: A 1-cm resection margins did not increase the risk of LR. Margin width did not make a significant difference in DSS or OS. Larger resection margins increase the need for a graft or flap closure.

PubMed Disclaimer

Conflict of interest statement

DISCLOSURE The authors declare they do not have any significant conflicts of interest to report on this original research article.

Figures

FIG. 1
FIG. 1
Kaplan–Meier plots by resection margin width for a local recurrence-free survival, b overall survival, and c disease-specific survival
See this image and copyright information in PMC

Comment in

References

    1. Toker C Trabecular carcinoma of the skin. Arch Dermatol. 1972;105:107–10. - PubMed
    1. Paulson KG, Park SY, Vandeven NA, Lachance K, Thomas H, Chapuis AG, et al. Merkel cell carcinoma: current United States incidence and projected increases based on changing demographics. J Am Acad Dermatol. 2018;78:457–63. - PMC - PubMed
    1. Swann MH, Yoon J. Merkel cell carcinoma. Semin Oncol. 2007;34:51–6. - PubMed
    1. Rollison DE, Giuliano AR, Becker JC. New virus associated with Merkel cell carcinoma development. J Natl Compr Cancer Netw. 2010;8:874–80. - PubMed
    1. Bichakjian CK, Olencki T, Alam M, Andersen JS, Berg D, Bowen GM, et al. Merkel cell carcinoma, version 1.2014. J Natl Compr Cancer Netw. 2014;12:410–24. - PMC - PubMed

MeSH terms

LinkOut - more resources