Pergolizzi J, Sardi A, Pelczar M, Conaway G L
Department of Surgical Oncology, St. Agnes HealthCare, Baltimore, Maryland 21229, USA.
Am Surg. 1997 May;63(5):450-4.
Merkel cell carcinoma is a rare and aggressive malignant tumor of the skin. We retrospectively reviewed five patients treated from January 1987 to December 1995. The mean age was 75 years (range, 65-85). There were three primary lesions of the head and neck and two of the extremities. Three were stage II and two were stage III. All primary tumors underwent wide excision with clear margins. Four patients recurred, with a mean time to recurrence of 10 months (range, 2-17). All tumors were positive for immunohistochemical stains (cytokeratin and neuron-specific enolase). Only the two patients who did not have radiotherapy to the primary site had a local recurrence. There was regional recurrence in two of the three patients who had adjuvant radiotherapy to regional lymph nodes. One patient who had a wide excision of the primary lesion, prophylactic lymph node dissection (15 of 34 lymph nodes were positive), and adjuvant chemotherapy is alive and disease free at 23 months. Three patients have died with disease, and two are alive and disease free. Merkel cell carcinoma should be treated aggressively with wide excision of the primary lesion (3-cm margins), and prophylactic lymphadenectomy followed by irradiation to the primary site. If lymph node involvement is detected, then irradiation to the lymph node region must be performed. The role of chemotherapy in this disease is not well defined.
默克尔细胞癌是一种罕见且侵袭性强的皮肤恶性肿瘤。我们回顾性分析了1987年1月至1995年12月期间接受治疗的5例患者。平均年龄为75岁（范围65 - 85岁）。头颈部有3例原发性病变，四肢有2例。3例为Ⅱ期，2例为Ⅲ期。所有原发性肿瘤均行切缘阴性的广泛切除。4例患者复发，平均复发时间为10个月（范围2 - 17个月）。所有肿瘤免疫组化染色（细胞角蛋白和神经元特异性烯醇化酶）均为阳性。仅2例未对原发部位进行放疗的患者出现局部复发。3例接受区域淋巴结辅助放疗的患者中有2例出现区域复发。1例患者对原发性病变进行了广泛切除、预防性淋巴结清扫（34个淋巴结中有15个阳性）并接受辅助化疗，在23个月时存活且无疾病。3例患者死于疾病，2例存活且无疾病。默克尔细胞癌应积极治疗，对原发性病变进行广泛切除（切缘3 cm），并进行预防性淋巴结切除，随后对原发部位进行放疗。如果检测到淋巴结受累，则必须对淋巴结区域进行放疗。化疗在这种疾病中的作用尚不明确。
