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MERKEL CELL CARCINOMA IN WAIKATO HOSPITAL, NEW ZEALAND
Author(s) -
Mistry Y. N.,
Mafi D.,
Pandita A.,
Alkadhi A.
Publication year - 2009
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2009.04927_36.x
Subject(s) - medicine , merkel cell carcinoma , stage (stratigraphy) , radiation therapy , neck dissection , head and neck , general surgery , lymph node , cancer , surgery , carcinoma , paleontology , biology
Purpose: To compare our Merkel cell carcinoma (MCC) patients and their respective management with current national and international standards. Methodology: Retrospective descriptive audit at Waikato Hospital between the years 2000 and 2008. Patients identified by Hospital's Pathlab database. Data included demographics, speciality involvement, tumour biology, tumour stage, treatment modalities and MDM involvement. All patients placed into the updated Memorial Sloan Kettering Cancer Centre (MSKCC) staging system for MCC to aid in analysis of management. Results: 22 patients identified (∼10% of all reported cases in NZ over this period). Majority were head and neck cases (55%) in elderly European patients. Plastic Surgery was the Primary speciality for 58% of cases. MSKCC stages were 27.3% stage 1; 18.2% stage 2; 45.5% stage 3; 9.1% stage 4. Stage I & 2 patients had variable WLE margins (4 mm–50 mm) and only 50% referred for radiotherapy. Stage 3 patients mainly treated with lymph node dissection (70%), radiotherapy (100%), and occasionally chemotherapy (30%). MDM involvement accounted for 54% of Head and Neck MCC cases and 0% for other anatomical locations of MCC. Conclusion: Waikato Hospital lacks consistency in management of patients at all stages for MCC. It is crucial to have clear excision margins, advise minimal margins of 11 mm. All stage 2 and 3 patients should be referred for radiotherapy. Multimodality treatment is required in the vast majority of these cases. Hence a multidisciplinary TEAM approach to management is recommended.