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Karl D. Lewis, MD


Consensus-Based Guidelines: New European Take on Merkel Cell Carcinoma

By: Celeste L. Dixon
Posted: Thursday, September 1, 2022

Primarily because of advances in systemic treatments and the newest (8th edition) American Joint Committee on Cancer/Union for International Cancer Control staging system for patients with Merkel cell carcinoma, a team of European specialists have reworked the existing European consensus-based interdisciplinary guidelines for the management of this disease, last updated in 2015. The project was undertaken on behalf of the European Dermatology Forum, the European Association of Dermato-Oncology, and the European Organization for Research and Treatment of Cancer.

The guidelines feature “a newer approach to definitions, risk classification, and multidisciplinary therapeutic strategies,” wrote Céleste Lebbé, MD, of Université de Paris, and colleagues in the European Journal of Cancer. Dr. Lebbé and colleagues said they based their work, in part, on other recent guidelines, including 2019’s German S2k guidelines and version 1.2021 of the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology for Merkel cell carcinoma.

Among the guideline writers’ goals, they stated, were to formulate specific sections to support clinicians in all Merkel cell carcinoma–related efforts: diagnosis, treatment, and follow-up. To this end, “particular emphasis [was] given to [this cancer’s] definition, epidemiology, molecular pathogenesis, clinical and histopathological diagnosis, staging, [and] management.”

The guideline specifics for patients with Merkel cell carcinoma include:

  • Baseline whole-body imaging postdiagnosis to rule out regional and distant metastases
  • Surgical excision as first-line treatment for localized disease, followed by postoperative margin assessment and adjuvant radiation therapy
  • Sentinel lymph node biopsy for all patients without clinically detectable lymph nodes or distant metastases
  • Adjuvant radiation therapy alone, eventually combined with complete lymph node dissection, if there is micrometastatic nodal involvement
  • Complete lymph node dissection, potentially followed by postoperative radiation therapy, when there is macroscopic nodal involvement
  • Immunotherapy with anti–PD-1 and/or anti–PD-L1 antibodies as first-line systemic treatment in advanced disease
  • Chemotherapy as an option when patients do not respond to or are intolerant of anti–PD-1 and/or anti–PD-L1 immunotherapy or clinical trial treatments.

Disclosure: The study authors’ disclosure information can be found at

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