Merkel cell carcinoma: therapeutic discussion about two cases

Abstract

AbstractPurpose Merkel cell carcinoma is a rare cutaneous neuroendocrine tumor. Its incidence is estimated 0.34/100000 in the U.S. Caucasian population. The Merkel cell carcinoma is a tumor of rapid change with a high malignant potential. Indeed, the survival rate at 3 years was estimated at 68%. Eyelid localization is meanwhile 5‐10 % of Merkel cell carcinoma. The median age of diagnosis is 69 years. It is then in the form of an inflammatory nodule that may be confused with a chalazion.Methods We present two clinical cases of Merkel cell carcinoma of the eyelid, initially confused with chalazion. The staging was performed by PET scan. The first case was classified T1N0M0 carcinoma, the second a classified TxN0M0 carcinoma. Both cases underwent surgical excision healthy margin. The first case is a simple excision, the second flap rotation of the lower eyelid. During follow up the second case received radiotherapy for loco regional reached.Results There is no current consensus for the treatment of Merkel cell carcinoma in the eyelid location. Its management is complex and must be multidisciplinary. Mohs micrographic surgery is the technique of choice. To secure tumor margins, radiotherapy seems to be an interesting adjuvant treatment for tumors larger than 2 cm. The sentinel nodetechnique can avoid unnecessary lymphadenectomy. Combination of radiotherapy and sentinel lymph node procedure may improved survival.Conclusion Merkel cell carcinoma is probably a virally induced cancer: a recent prospective study shows a significant association between infection with polyomavirus MCV and Merkel cell carcinoma. New therapy should happen quickly in the future.