Veness Michael, Howle Julie
Department of Radiation Oncology, University of Sydney, Westmead Hospital, Sydney, New South Wales, Australia.
Australas J Dermatol. 2010 Nov;51(4):274-8. doi: 10.1111/j.1440-0960.2010.00702.x. Epub 2010 Oct 13.
To review the management of patients with Merkel cell carcinoma (MCC) of the distal arm or leg.
The files of 27 patients with clinically node-negative extremity-located MCC treated between 1993 and 2007 at Westmead Hospital, Sydney, were reviewed.
The median age was 79 (range 48-91 years); there were 16 women and 11 men. The median follow up was 36 months. Eighteen patients had a below knee primary and nine had a below elbow primary. None had previous treatment of draining nodes. Most (26/27) underwent excision and 10 of the 27 received adjuvant local radiotherapy. The median lesion size was 19 mm (range 10-30 mm). In total 55% relapsed with most occurrences in the ipsilateral nodes of the axilla or groin. Median time to relapse was 5.5 months. Overall survival at two and five years was 68% and 57%, respectively.
Patients with extremity MCC experience a high rate of nodal relapse. Recently published evidence supports a survival benefit to identifying patients with microscopic nodal metastases. As en bloc primary and nodal treatment is not possible, and elective nodal treatment is likely to over-treat many patients, sentinel lymph node biopsy is a useful adjunct to current investigations and should be recommended.
回顾远端手臂或腿部默克尔细胞癌（MCC）患者的治疗情况。
回顾了1993年至2007年间在悉尼韦斯特米德医院接受治疗的27例临床淋巴结阴性的肢体MCC患者的病历。
中位年龄为79岁（范围48 - 91岁）；女性16例，男性11例。中位随访时间为36个月。18例患者原发灶位于膝下，9例位于肘下。均未对引流淋巴结进行过先前治疗。大多数患者（26/27）接受了切除手术，27例中有10例接受了辅助局部放疗。病变中位大小为19毫米（范围10 - 30毫米）。共有55%的患者复发，大多数复发发生在腋窝或腹股沟的同侧淋巴结。中位复发时间为5.5个月。两年和五年的总生存率分别为68%和57%。
肢体MCC患者淋巴结复发率高。最近发表的证据支持识别有微小淋巴结转移的患者可带来生存获益。由于无法进行原发灶和淋巴结的整块切除，且选择性淋巴结治疗可能会过度治疗许多患者，前哨淋巴结活检是当前检查的有用辅助手段，应予以推荐。
