What Is the Ideal Resection Margin in Head and Neck Merkel Cell Carcinoma?

  • Cheryl C. NoconEmail author
  • Mihir K. Bhayani
Part of the Difficult Decisions in Surgery: An Evidence-Based Approach book series (DDSURGERY)


Merkel cell carcinoma (MCC) is a rare neurocutaneous malignancy, most commonly occurring in the head and neck. Although definitive treatment most often consists of surgical excision, the management of head and neck MCC provides a unique surgical challenge due to the complex anatomy and the functional and cosmetic implications of treatment. Although strong evidence for head and neck MCC surgical margin recommendations are lacking, a surgical resection margin of up to 1–2 cm may be considered adequate without compromising disease control. While obtaining negative margins is an objective in oncologic surgery, it should not be pursued if there will be significant delays to adjuvant therapy, as current data suggest that margin status may not have an impact on disease control in patients receiving adjuvant therapy.


  1. 1.
    Tai P. A practical update of surgical management of Merkel cell carcinoma of the skin. ISRN Surg. 2013;2013:1–17.CrossRefGoogle Scholar
  2. 2.
    Muller-Richter UDA, Gesierich A, Kubler AC, Hartmann S, Brands RC. Merkel cell carcinoma of the head and neck: recommendations for diagnostics and treatment. Ann Surg Oncol. 2017;24:3430–7.CrossRefGoogle Scholar
  3. 3.
    Morand GB, Madana J, DaSilva SD, et al. Merkel cell carcinoma of the head and neck: poorer prognosis of than non-head and neck sites. J Laryngol Otol. 2016;130:393–7.CrossRefGoogle Scholar
  4. 4.
    Hughes MP, Hardee ME, Cornelius LA, et al. Merkel cell carcinoma: epidemiology, target and therapy. Curr Dermatol Rep. 2014;3:46–53.CrossRefGoogle Scholar
  5. 5.
    Miles BA, Goldenberg D. Merkel cell carcinoma: do you know your guidelines? Head Neck. 2016;38:647–52.CrossRefGoogle Scholar
  6. 6.
    Lebbe C, Becker JC, Grob JJ, et al. Diagnosis and treatment of Merkel cell carcinoma. European consensus-based interdisciplinary guideline. Eur J Cancer. 2015;51:2396–403.CrossRefGoogle Scholar
  7. 7.
    Durbec M, Couloigner V, Tronche S, et al. Guidelines of the French Society of Otorhinolaryngology (SFORL), short version. Extension assessment and principles of resection in cutaneous head and neck tumors. Eur Ann Otorhinolaryngol Head Neck. 2014;131:375–83.CrossRefGoogle Scholar
  8. 8.
    Gillenwater AM, Hessel AC, Morrison WH, et al. Merkel cell carcinoma of the head and neck: effect of surgical excision and radiation on recurrence and survival. Arch Otolaryngol Head Neck Surg. 2001;127:149–54.CrossRefGoogle Scholar
  9. 9.
    Morand G, Vital D, Pezier T, et al. Merkel cell carcinoma of the head and neck: a single institution experience. J Skin Cancer. 2013;2013:1–7.CrossRefGoogle Scholar
  10. 10.
    Allen PJ, Bowne WB, Jaques DP, et al. Merkel cell carcinoma: prognosis and treatment of patients from a single institution. J Clin Oncol. 2005;23(10):2300–9.CrossRefGoogle Scholar
  11. 11.
    Fields RC, Busam KJ, Chou JF, et al. Five hundred patients with Merkel cell carcinoma evaluated at a single institution. Ann Surg. 2011;254:465–75.CrossRefGoogle Scholar
  12. 12.
    Perez MC, de Pinho FR, Holstein A, et al. Resection margins in Merkel Cell Carcinoma: is a 1-cm margin wide enough? Ann Surg Oncol. 2018;25(11):3334–40.CrossRefGoogle Scholar
  13. 13.
    Finnigan R, Hruby G, Wratten C, et al. The impact of preradiation residual disease volume on time to locoregional failure in cutaneous Merkel cell carcinoma: a TROG substudy. Int J Radiat Oncol Biol Phys. 2013;86(1):91–5.CrossRefGoogle Scholar
  14. 14.
    Strom T, Naghavi AO, Messina JL, et al. Improved local and regional control with radiotherapy for Merkel cell carcinoma of the head and neck. Head Neck. 2017;39:48–55.CrossRefGoogle Scholar
  15. 15.
    Bishop AJ, Garden AS, Gunn B, et al. Merkel cell carcinoma: favorable outcomes with radiotherapy. Head Neck. 2015;38:E452–8.CrossRefGoogle Scholar
  16. 16.
    Smith VA, Camp ER, Lentsch EJ. Merkel cell carcinoma: identification of prognostic factors unique to tumors located in the head and neck based on analysis of SEER data. Laryngoscope. 2012;122:1283–90.CrossRefGoogle Scholar
  17. 17.
    Lok B, Khan S, Mutter R, et al. Selective radiotherapy for the treatment of head and neck Merkel cell carcinoma. Cancer. 2012;118:3937–44.CrossRefGoogle Scholar
  18. 18.
    Clark JR, Veness MJ, Gilbert R, O’Brien CJ, Gullane PJ. Merkel cell carcinoma of the head and neck: is adjuvant radiotherapy necessary? Head Neck. 2007;29:249–57.CrossRefGoogle Scholar
  19. 19.
    Chen MM, Roman SA, Sosa JA, Judson BL. The role of adjuvant therapy in the management of head and neck Merkel cell carcinoma: an analysis of 4815 patients. JAMA Otolaryngol Head Neck Surg. 2015;141(2):137–41.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Division of Otolaryngology—Head and Neck Surgery, Department of SurgeryNorthShore University HealthSystemEvanstonUSA

Personalised recommendations