Original article
The impact of 18F-FDG PET-CT scanning for staging and management of Merkel cell carcinoma: Results from Westmead Hospital, Sydney, Australia

https://doi.org/10.1016/j.jaad.2009.06.021Get rights and content

Background

Merkel cell carcinoma (MCC) is a rare cutaneous malignancy with high mortality. Positron emission tomography (PET) using 18F-fluorodeoxyglucose (FDG) has been shown to be valuable in the management of many types of cancer, and the purpose of this work was to determine its utility for patients with MCC.

Objective

We sought to evaluate the impact of 18F-FDG PET with simultaneous computed tomography (PET-CT) on the staging and management of patients with MCC.

Methods

We reviewed the medical records of 18 patients with MCC who underwent 21 PET-CT scans at our institution from 2006 to 2008. The impact of PET-CT on staging and management plans were evaluated.

Results

There were 12 men and 6 women with median age of 79 years (range, 54 to 85 years). All proven sites of MCC greater than 5 mm were positive on PET-CT with average maximum standardized uptake values (SUV max) of 4 in primary lesions, 5.6 in nodal disease and 11.5 in distant metastases. PET-CT contributed to altered staging in 7 patients (33%) and a change in management in 9 patients (43%). Two patients were found to have a second primary malignancy, but this did not alter management.

Limitations

This was a retrospective review. Most patients had stage II or III disease, suggesting some potential referral bias.

Conclusions

18F-FDG PET-CT had a high impact in the management of MCC patients in our series and this investigation merits further assessment.

Section snippets

Methods

Two of the authors (R.C., M.V.) retrospectively reviewed the records (prospectively acquired data) of 18 select patients undergoing 21 PET-CT scans for management of MCC at our institution from 2006 to 2008. Common indications for scanning were suspected nodal or distant disease not clinically detected at initial diagnosis (n = 12), or in the setting of disease relapse (n = 9). During this period, most patients with obvious clinical stage I or IV disease were generally prescribed treatment

Presentation

Patient demographics are presented in Table I. Median age at first scan was 79 years (range, 54 to 85 years), and median duration of follow-up was 9 months (range, 1 to 27 months). Changes in stage or management following PET-CT are presented in Table II. PET-CT scans were performed for assessment of stage at initial presentation (n = 12) or following relapse (n = 9). Six of 12 patients (50%) undergoing PET-CT for first presentation had previously undergone excision of the primary lesion prior

Discussion

MCC was originally described by Toker18 in 1972. It derives from Merkel cells, which are found in the dermoepidermal junction and are generally considered neuroendocrine cells with mechanoreceptor function. MCC is an aggressive tumor, with cause-specific mortality exceeding that of melanoma.19 It is associated with high rates of early (<12 months) relapse, with reports of many patients eventually developing regional nodal and distant metastatic disease.17, 20, 21

The largest reported series of

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    Funding sources: None.

    Conflicts of interest: None declared.

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