Surgical treatment of Merkel cell carcinoma of the head and neck: Experiences from a single-center cohort.

Merkel cell carcinoma (MCC) is a rare malignancy, with about half of cases affecting the head and neck region. This retrospective study evaluated risk factors and survival outcomes in 89 patients (47 females, 42 males, median age: 77 years) treated with curative surgical therapy ± adjuvant therapy at a single center from 2010 to 2023. Most patients (71.9 %) presented with UICC stage I-II disease, while 28.1 % were diagnosed with stage III disease. Among the 55 patients undergoing surgical neck management, the lymph node metastasis rate was 40.0 %. Adjuvant therapy was completed in 67.5 % of patients. In the 81 patients eligible for survival analysis, the two-year overall survival (OS) was 78.8 %, and disease-free survival (DFS) was 57.2 %. Multivariable Cox regression identified completion of adjuvant therapy as a statistically significant factor of improved OS (HR 0.154; p = 0.00611). UICC stage III was significantly associated with worse DFS (HR 10.507; p = 0.00656). Additionally, a lymph node yield of more than 3 nodes was linked to worse OS (HR 4.337; p = 0.0456) and DFS (HR 3.468; p = 0.0355). This study highlights the high rate of lymph node metastasis in MCC and its detrimental impact on survival, emphasizing the importance of aggressive, guideline-concordant multimodal treatment for improved outcomes.