Site Editor
Soo Park, MD
Soo Park, MD
Posted: Tuesday, March 26, 2024
Should the current guidance surrounding de-escalating surveillance after a patient has been treated for Merkel cell carcinoma be revisited? Using an unusual case study as a starting point, Robert J. Pariser, MD, of Eastern Virginia Medical School, Norfolk, and colleagues addressed this topic as a poster at the 2024 American Academy of Dermatology Association (AAD) Annual Meeting (Poster 54433).
The patient was a 94-year-old woman who had a 1-cm pink eroded nodule on her finger. She had successfully had a stage I Merkel cell carcinoma lesion of the left nasal wall removed 21 years earlier. No evidence of the cancer was present in the excisional specimen.
“Although some studies suggest that patients who are free of recurrence 3 years after initial diagnosis may receive de-escalating surveillance, this case emphasizes the possibility of a very late second Merkel cell carcinoma vs a very late recurrence,” noted Dr. Pariser and co-investigators. The patient’s finger nodule was a typical Merkel cell carcinoma, featuring “expansion of the dermis with sheets and nests of small, basophilic cells with nuclear molding and minimal cytoplasm. Apoptotic cells and mitoses were present, [and] immunohistochemistry was positive for CD56, synaptophysin, and CK20 (perinuclear dotting).”
Nonstage factors for planning surveillance generally include male sex, immune suppression, and advanced age, the team acknowledged, and recurrence of Merkel cell carcinoma is most likely to occur 1 to 3 years after diagnosis. This case, however, supports “continuous surveillance even beyond this time frame.” The National Comprehensive Cancer Network recommends complete skin and lymph node examinations every 3 to 6 months for the first 3 years after initial diagnosis and every 6 to 12 months thereafter.
Disclosure: The study authors reported no conflicts of interest.
JNCCN Spotlights
