Dermatologic surgeryDemographics and outcomes of stage I and II Merkel cell carcinoma treated with Mohs micrographic surgery compared with wide local excision in the National Cancer Database
Section snippets
Study population
All cases of early-stage MCC without clinical evidence of nodal disease treated with MMS or WLE from 1998 to 2011 were identified in the National Cancer Database (NCDB), an oncology database sourced from more than 1500 accredited cancer facilities in the United States (49 of 50 states) and Puerto Rico.7 The NCDB is reported to collect approximately 70% of all new cancer diagnoses in the United States each year, and it receives cases from more than 1430 teaching/research hospitals, community
Results
Table II displays all relevant patient and tumor characteristics. A total of 1795 cases of stage I or II MCC were identified in the NCDB as being treated with WLE (n = 1685) or MMS (n = 110). There was no difference in age distribution (P = .754), sex (P = .316), race (white or nonwhite [P = .767]), Charlson-Deyo score (P = .061), or insurance status (P = .229) between patients treated with WLE or MMS. MMS was more likely to be performed at an academic institution than was WLE (65.5% vs 46.9% [P
Discussion
We determined that MMS is more commonly performed at academic centers and on smaller tumors (T1) in the head and neck region. Our study revealed greater 3-year actuarial survival of patients with T1 tumors than with T2 and T3 tumors, validating prior studies that also showed a reduced survival advantage with increasing tumor size.10, 11, 12 No difference was demonstrated in the reported positivity of surgical margins in the WLE and MMS surgical groups. This implies that neither treatment
Conclusions
This is, to our knowledge, the first use of a national cancer database registry comparing MMS and WLE for the treatment of stage I and II MCC. We determined that there was no difference in OS between the 2 treatment modalities. MMS appears to be as efficacious as WLE in the treatment of early-stage MCC. This has implications particularly in the head and neck region, where MMS has the advantage of providing tissue conservation in cosmetically and functionally sensitive areas. Adjuvant radiation
References (22)
- et al.
Diagnosis and treatment of Merkel cell carcinoma. European consensus-based interdisciplinary guideline
Eur J Cancer
(2015) - et al.
Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives
J Clin Epidemiol
(1993) - et al.
Relationships among primary tumor size, number of involved nodes, and survival for 8044 cases of Merkel cell carcinoma
J Am Acad Dermatol
(2014) - et al.
Mohs micrographic surgery for the treatment of basal cell carcinoma
Actas Dermosifiliogr
(2010) - et al.
Local control of primary Merkel cell carcinoma: review of 45 cases treated with Mohs micrographic surgery with and without adjuvant radiation
J Am Acad Dermatol
(2002) - et al.
Frequent detection of Merkel cell polyomavirus in human Merkel cell carcinomas and identification of a unique deletion in the VP1 gene
Cancer Res
(2008) - et al.
NIH public access
Clin Lymphoma
(2010) Merkel's cell carcinoma in organ recipients: report of 41 cases
Transplantation
(1999)- et al.
Merkel cell carcinoma in organ-transplant recipients: report of two cases with unusual histological features and literature review
J Cutan Pathol
(2006) Merkel cell carcinoma. Version 1.2017—October 3, 2016
The National Cancer Data Base: past, present, and future
Ann Surg Oncol
Cited by (0)
Drs Truong and Sahni are colast authors.
Funding sources: None.
Conflicts of interest: None disclosed.