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Qasiem J. Nasser, Adeel Khan, William Morrison, Tarek El-Sawy, Steven Frank, Bita Esmaeli; Multi-disciplinary Management Of Eyelid Merkel Cell Carcinoma. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5612.
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© ARVO (1962-2015); The Authors (2016-present)
Merkel Cell Carcinoma (MCC) is a rare and aggressive cancer of the eyelid with high local recurrence rates and estimated regional nodal and distant metastasis rates as high as 30-50%. Some controversy exists regarding the multi-disciplinary management of MCC. This maybe particularly important for MCC of the eyelid where the lymphatic drainage maybe less predictable than in other sites and the risk of ocular toxicity from radiation therapy is not negligible. The purpose of this study is to review the management algorithms for eyelid MCC.
The medical records of 8 patients with histologically proven eyelid MCC treated by the senior author (BE) between April 2004 and November 2011 were reviewed. The outcome measures included tumor size and location at presentation, nodal status at presentation, local therapy, treatment for regional nodes, distant metastasis, recurrence and clinical outcome at last follow up.
5 women and 3 men ranged in age from 55 to 86 years old (median, 68.5 years). AJCC 7th edition TNM designations were: T2aN0M0, 3 patients; T2bN0M0, 2 patients; T3aN0M0, 1 patient; and T3aN1M0, 2 patients. All patients had surgical excision of their eyelid MCC with negative microscopic margins followed by post operative radiation therapy at a dose range of 50-60 Gy to the tumor bed. 3 patients had sentinel lymph node (SLN) biopsy at the time of surgical excision of the eyelid MCC.Systemic chemotherapy was administered in 4 of our patients; 2 who developed recurrence of the disease following treatment by surgery and radiation therapy, 1 who initially presented with regional lymph node metastasis, and another who had a T3aN0M0 with tumor diameter of 34mm in its greatest dimension but no regional or distant metastasis.No tumors less than T2b had recurrence, regional or distant metastasis.Our median follow up period was 31 months. At last follow up, 1 of the 3 patients who presented with a T2aN0M0 tumor was lost to follow up and expired from other co-morbidities. 1 of the 2 patients who presented with a T2bN0M0 tumor has developed pancreatic metastasis. Finally, 1 of the 2 patients who presented with a T3aN1M0 tumor developed recurrence of disease and died while receiving chemotherapy. The remaining 5 patients are alive with no evidence of disease.
Multi-disciplinary management of MCC of the eyelid may include surgery, post operative adjuvant radiation therapy to the eyelid bed, sentinel lymph node biopsy, or prophylactic radiotherapy to the regional lymph nodes at risk, and systemic therapies. Tumors less than T2b on presentation, are unlikely to recur or metastasize following surgical excision and radiotherapy.
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