Elsevier

Current Problems in Cancer

Volume 34, Issue 1, January–February 2010, Pages 65-76
Current Problems in Cancer

Imaging of Merkel Cell Carcinoma

https://doi.org/10.1016/j.currproblcancer.2010.01.003Get rights and content

Section snippets

Initial Imaging of Clinically Node-Negative Primary MCC

To date, there is no consensus in the published data as to how localized primary MCC should be evaluated before surgical intervention. This is most true in those patients present without evidence of regional or distant metastases (which is most MCC patients upon presentation). We feel that the most important aspect of management of patients with clinically localized MCC is evaluation of the regional nodal basins with SLNB. Of course, any patient who is experiencing symptoms that would suggest

Regional Nodal Evaluation—SLNB

Clinical studies, albeit with relatively small numbers of patients, have demonstrated the reliability of SLNB in identifying regional nodal metastases in patients presenting with clinically localized MCC. Messina et al2 reported the utility of SLNB in MCC back in 1997. The authors reported that 2 of 12 (16%) patients with clinically negative regional nodal basins had a positive sentinel node biopsy, and the remaining 10 node-negative patients had not experienced a nodal recurrence in a maximum

The Role of Ultrasound in Evaluating Regional Nodal Basins

Increasingly, ultrasound is being used to evaluate regional nodal basins in breast cancer and melanoma,11, 13, 14, 15, 16 and the experience we and others have gained with ultrasound in these malignancies has prompted us to extend its use to selected patients with MCC. Most centers with experience with preoperative ultrasound evaluation of clinically negative nodal basins for melanoma have consistently shown that sentinel node biopsy is much more sensitive for detecting nodal metastasis than

Imaging of Patients With Stage III Disease

In cases where regional lymph nodes are suspected to be involved on the basis of physical examination, fine needle aspiration cytology is the preferred approach to confirm the diagnosis before definitive treatment. Ultrasound guidance is frequently used to maximize the likelihood of accurately sampling the suspect node. After a diagnosis of a positive lymph node, we will routinely image these patients with high resolution cross-sectional body imaging, using contrast-enhanced CT scans and/or PET

MCC From Unknown Primary Sites

MCC occasionally presents with metastatic disease involving lymph nodes or distant sites in the absence of a clinically evident cutaneous primary tumor. As is the case with metastatic melanoma from an unknown primary site, regression of the primary tumor or removal or ablation of the primary without obtaining a correct histologic diagnosis may explain some cases. In cases of apparent unknown primary MCC, however, one must also consider the possibility of unrecognized small cell lung carcinoma

Imaging During Follow-Up

The median time to recurrence of MCC after unsuccessful surgical treatment is approximately 8 months. A maximum of 90% of recurrences will occur by 2 years.1 We pay particular attention to nodal basins at risk for relapse, and use nodal ultrasound every 3-6 months for surveillance of those patients who did not have SLNB, as well as in patients who had a positive SLNB but did not undergo a completion regional lymphadenectomy or nodal irradiation. After the first 2 years, these regional nodal

Conclusions

Recommendations for imaging of MCC, for example as provided in the 2008 Guidelines of the National Comprehensive Cancer Network, are vague at best: “as clinically indicated.”36 The rarity and clinical variability of MCC has so far prevented the completion of meaningful randomized trials that might provide data-driven preferences for one imaging modality over another in specific situations. This uncertainty applies both to staging and surveillance phases of management. At Moffitt Cancer Center,

First page preview

First page preview
Click to open first page preview
View PDF

References (36)

  • A.I. Willis et al.

    Discordant lymphatic drainage patterns revealed by serial lymphoscintigraphy in cutaneous head and neck malignancies

    Head Neck

    (2007)
  • L. Jansen et al.

    Sentinel node biopsy for melanoma in the head and neck region

    Head Neck

    (2000)
  • E.H. Doting et al.

    Does sentinel lymph node biopsy in cutaneous head and neck melanoma alter disease outcome?

    J Surg Oncol

    (2006)
  • T.K. Lam et al.

    False-negative sentinel node biopsy because of obstruction of lymphatics by metastatic melanoma: the value of ultrasound in conjunction with preoperative lymphoscintigraphy

    Melanoma Res

    (2009)
  • M.V. Mar et al.

    Evaluation and localization of lymphatic drainage and sentinel lymph nodes in patients with head and neck melanomas by hybrid SPECT/CT lymphoscintigraphic imaging

    J Nucl Med Technol

    (2007)
  • C. Voit et al.

    Ultrasound-guided fine needle aspiration cytology prior to sentinel lymph node biopsy in melanoma patients

    Ann Surg Oncol

    (2006)
  • A. Blum et al.

    Ultrasound examination of regional lymph nodes significantly improves early detection of locoregional metastases during the follow-up of patients with cutaneous melanoma: results of a prospective study of 1288 patients

    Cancer

    (2000)
  • J.T. Davis et al.

    Ultrasound-guided fine-needle aspiration of clinically negative lymph nodes versus sentinel node mapping in patients at high risk for axillary metastasis

    Ann Surg Oncol

    (2006)

    • Cited by (18)

    • Merkel cell carcinoma and <sup>18</sup>FDG PET-CT: A case report

      2021, Medecine Nucleaire
      Citation Excerpt :

      Strategy: when Merkel cell carcinoma is localized, the focus is on assessment of lymph node status using ultrasound and the sentinel lymph node technique. If the tumor sample (biopsy or excision sample) does not express cytokeratin 20, thoracoabdominal imaging (chest X-ray with abdomino-pelvic ultrasound or, as a better option, thoraco-abdomino-pelvic CT) is often recommended for detection of the primary carcinoma (which may be bronchial) responsible for the cutaneous metastasis [27,28]. Patients with lymph node invasion, invasive margins at the excision site, or large tumors (greater than 2 cm in size) without clinical lymph node involvement are thought to have a high risk of recurrence.

    • Nonmelanoma Skin Cancers: Basal Cell and Squamous Cell Carcinomas

      2019, Abeloff’s Clinical Oncology

    • Merkel Cell Carcinoma: An Update of Key Imaging Techniques, Prognostic Factors, Treatment, and Follow-up

      2017, Actas Dermo-Sifiliograficas
      Citation Excerpt :

      Analysis of alkaline phosphatases, as markers of liver disease, and serology to detect MCPyV are also recommended, and are scheduled at the same time as examinations. Zager et al.8 suggested that, as in melanoma, ultrasound studies of the regional lymph nodes should be done every 3 to 6 months in patients at high risk of locoregional recurrence. After the first 2 years of follow-up, these studies may be done on a 6-to-12 month schedule.

    • Specialty Imaging: PET

      2017, Specialty Imaging: PET

    • Imaging in Merkel Cell Carcinoma

      2016, Imaging in Dermatology

    • Nonmelanoma Skin Cancers: Basal Cell and Squamous Cell Carcinomas

      2013, Abeloff's Clinical Oncology: Fifth Edition
    View all citing articles on Scopus
    View full text
    Copyright © 2010 Mosby, Inc. All rights reserved.