Messina J L, Reintgen D S, Cruse C W, Rappaport D P, Berman C, Fenske N A, Glass L F
Department of Pathology, University of South Florida College of Medicine, Tampa 33612, USA.
Ann Surg Oncol. 1997 Jul-Aug;4(5):389-95. doi: 10.1007/BF02305551.
Merkel cell carcinoma (MCC) is an aggressive cutaneous tumor with a propensity for local recurrence, regional and distant metastases. There are no well-defined prognostic factors that predict behavior of this tumor, nor are treatment guidelines well established.
Staging of patients with a new diagnosis of MCC was attempted using selective lymphadenectomy concurrent with primary excision. Preoperative and intraoperative mapping, excision, and thorough histologic evaluation of the first lymph node draining the tumor primary site [sentinel node] was performed. Patients with tumor metastasis in the sentinel node underwent complete resection of the remainder of the lymph node basin.
Twelve patients underwent removal of 22 sentinel nodes. Two patients demonstrated metastatic disease in their sentinel lymph nodes, and complete dissection of the involved nodal basin revealed additional positive nodes. The node-negative patients received no further surgical therapy, with no evidence of recurrent local or regional disease at a maximum of 26 months follow-up (median 10.5 months).
While the data are preliminary and initial follow-up is limited, early results suggest that sentinel lymph node mapping and excision may be a useful adjunct in the treatment of MCC. This technique may identify a population of patients who would benefit from further surgical lymph node excision.
默克尔细胞癌（MCC）是一种侵袭性皮肤肿瘤，易于局部复发、区域及远处转移。目前尚无明确的预后因素可预测该肿瘤的行为，治疗指南也未完全确立。
对新诊断为MCC的患者进行分期时，尝试在原发切除的同时行选择性淋巴结清扫术。对肿瘤原发部位的首站引流淋巴结（前哨淋巴结）进行术前及术中定位、切除，并进行全面的组织学评估。前哨淋巴结有肿瘤转移的患者，对其余淋巴结区域进行完整切除。
12例患者共切除22个前哨淋巴结。2例患者的前哨淋巴结显示有转移性疾病，对受累淋巴结区域进行完整清扫后发现还有其他阳性淋巴结。淋巴结阴性的患者未接受进一步手术治疗，在最长26个月的随访期（中位随访期10.5个月）内，无局部或区域疾病复发的证据。
虽然数据是初步的且初始随访有限，但早期结果表明前哨淋巴结定位和切除可能是MCC治疗中的一项有用辅助手段。该技术可能识别出能从进一步手术切除淋巴结中获益的患者群体。
