Cotlar A M, Gates J O, Gibbs F A
Am Surg. 1986 Mar;52(3):159-64.
Merkel cell carcinoma, first reported as "trabecular carcinoma" by Toker in 1972, is a dangerous, often fatal primary skin tumor. The current authors report eight patients, only one of whom is considered to have a totally successful clinical outcome. Two patients died and one was preterminal with widespread disease in 10 to 20 months. Two others had recurrence or metastases within a year, and two patients died early of intercurrent disease after first developing regional lymph node involvement. Review of 139 patients reported in the literature indicates local recurrence in 30 per cent, regional lymph node metastases in 50 per cent, and death from neoplasm in 18 per of the cases. All patients in the present series received radiation therapy with encouraging response. The tumor was quite radiosensitive, and in only one instance was there recurrence within an irradiated field. Wide surgical excision with prompt postoperative irradiation to the local site and regional lymphatics is the therapy of choice in early lesions. Regional lymphadenectomy is recommended whenever nodal involvement is suspected. Currently, an aggressive combined surgical and radio-therapeutic approach to this dangerous neoplasm appears warranted, although further data may show that early and routine use of radiotherapy in Merkel cell carcinoma could obviate the necessity for extensive operative procedures.
默克尔细胞癌于1972年由托克尔首次报告为“小梁癌”，是一种危险的、通常致命的原发性皮肤肿瘤。本文作者报告了8例患者，其中只有1例被认为临床结局完全成功。2例患者死亡，1例在10至20个月时处于疾病广泛播散的临终前状态。另外2例在1年内出现复发或转移，2例患者在首次出现区域淋巴结受累后因并发疾病早期死亡。对文献报道的139例患者的回顾表明，30%的病例出现局部复发，50%的病例出现区域淋巴结转移，18%的病例死于肿瘤。本系列所有患者均接受放射治疗，反应令人鼓舞。该肿瘤对放疗相当敏感，仅1例在放疗野内复发。早期病变的治疗选择是广泛手术切除并术后立即对局部和区域淋巴管进行放疗。只要怀疑有淋巴结受累，就建议进行区域淋巴结清扫术。目前，对这种危险的肿瘤采取积极的手术和放射治疗联合方法似乎是必要的，尽管进一步的数据可能表明，在默克尔细胞癌中早期和常规使用放疗可以避免进行广泛手术的必要性。
