Abstract
Purpose :
Merkel cell carcinoma (MCC) is a rare, aggressive skin cancer that is often initially misdiagnosed, resulting in potential delays in management and poor clinical outcomes. We performed a retrospective, cross-sectional study to evaluate whether initial clinical impression and management of MCC varied based on provider characteristics.
Methods :
We identified and included all patients (n=11) with a pathologic diagnosis of periocular MCC at Massachusetts Eye & Ear from 2010-2022. Time from symptom onset to initial presentation, biopsy, and definitive treatment were manually collected, along with providers’ clinical specialty and MCC management. Statistical analyses were conducted in Python using SciPy.
Results :
Patients diagnosed with MCC most often presented to ophthalmology (45%, n=5) followed by dermatology (27%, n=3), internal medicine (18%, n=2), and optometry (9%, n=1). Of cases with information available about initial management by ophthalmologists (n=4), 50% (n=2) relied on conservative management and 50% (n=2) biopsied. Non-ophthalmology providers biopsied in 20% of cases (n=1), while 80% (n=4) referred to other specialists. All (n=4) ophthalmologists and 50% (n=3) of non-ophthalmologists initially thought the lesions were benign, while 50% (n=3) of non-ophthalmologists (all dermatologists) were concerned for malignancy or a non-specific etiology; no providers reported MCC on their differential. Mean length of time from symptom onset to biopsy was 66.7 days (std=37.1). Time from first presentation to biopsy averaged 32.0 days (std=27.1) and was not significantly impacted by physician specialty (p=0.34). Similarly, specialty of provider performing the biopsy did not impact time from biopsy to treatment (p=0.85) with an average of 59.8 days (std=30.6).
Conclusions :
While initial clinical impression and management of MCC varied based on provider characteristics, time from patients’ first presentation to biopsy was not significantly different. Ophthalmologists initially chose conservative management more often than other specialties, but this did not significantly increase the average time from patient presentation to biopsy or from biopsy to treatment initiation. No providers initially considered MCC, though dermatologists had a higher concern for malignancy than other specialties. All specialties need to have a high index of suspicion for MCC lesions.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.