Recommandations du groupe de cancérologie cutanée de la Société française de dermatologie pour la prise en charge diagnostique et thérapeutique du carcinome à cellules de Merkel

Narrow resection margins are not associated with mortality or recurrence in patients with Merkel cell carcinoma: A retrospective study

BACKGROUND

Wide local excision constitutes the standard of care for Merkel cell carcinoma, but the optimal margin width remains controversial.

OBJECTIVES

To assess whether narrow margins (0.5-1 cm) were associated with outcome.

METHODS

Patients were recruited from a retrospective French multicentric cohort and included if they had had excision of primary tumor with minimum lateral margins of 0.5 cm. Factors associated with mortality and recurrence were assessed by multivariate regression.

RESULTS

Among the 214 patients included, 58 (27.1%) had undergone excision with narrow margins (0.5-1 cm) versus 156 (72.9%) with wide margins (>1 cm). During a median follow-up of 50.7 months, cancer-specific survival did not differ between groups (5-year specific survival rate 76.8% [95% confidence interval 61.7%-91.9%] and 76.2% [95% confidence interval 68.8%-83.6%], respectively). Overall survival, any recurrence-free survival, and local recurrence-free survival did not significantly differ between groups. Cancer-specific mortality was associated with age, male sex, American Joint Committee on Cancer stage III, and presence of positive margins.

LIMITATIONS

Retrospective design, heterogenous baseline characteristics between groups.

CONCLUSION

Excision with narrow margins was not associated with outcome in this cohort, in which most patients had clear margins and postoperative radiation therapy. Residual tumor, mostly found on deep surgical margins, was independently associated with prognosis.

[Care of Merkel cell carcinoma and role of the radiotherapy]

Merkel cell carcinoma is a rare neuro-endocrine tumor of skin with a poor prognosis. Data available in literature are scarce. Current treatment for locoregional disease is based on combined treatment by surgery and radiotherapy. However these treatments are controversial. The aim of the present review is to sum up the different available studies and to compare national and international guidelines.

[Cutaneous Merkel cell carcinoma: role of 18FDG PET-CT]

Merkel cell carcinoma (MCC) is a rare neuroendocrine carcinoma of the skin with unpredictable evolution and high metastatic potential. This neoplasm usually occurs in the elderly on their sun-exposed areas. CCM constant greed for 18 fluorodeoxyglucose (FDG) defines the role of positron emission tomography (PET) in this pathology. However, no consensus has yet been reached. This study reports the case of a 25 year old woman treated for metastatic MCC, in order to draw attention to this particular tumor and to illustrate the role of 18 FDG PET in the management of this rare entity.

[Primary cutaneous neuroendocrine carcinoma: report of a new case and literature review]

Le carcinome neuro- endocrine cutané primitif (CNEC) est une tumeur cutanée rare et agressive du sujet âgé, favorisée par le soleil et l'immunodépression. Elle est caractérisée par une évolution agressive avec un fort taux de récidive, une évolution ganglionnaire régionale et un risque de métastases à distance. Nous rapportons un cas de cette tumeur chez un patient âgé de 67 ans sous forme d'un placard nodulaire hémorragique mesurant 16 /14 cm. Le patient a bénéficié d'une exérèse chirurgicale large avec couverture de la perte de substance par un lambeau musculo-cutané du muscle grand dorsal, un curage ganglionnaire axillaire et une radiothérapie adjuvante. Après un recul de 2 ans et 2 mois, le patient est toujours vivant sans métastase ni récidive. La littérature étant pauvre, la prise en charge diagnostique et thérapeutique est controversée et donc hétérogène. Globalement le pronostic est mauvais, et certains paramètres corrélés au pronostic sont précisés.

Prevalence of polyomaviruses and links with human diseases

The simian virus 40 and murine polyomaviruses were shown to be DNA tumor viruses in their natural hosts and/or heterologous experimental hosts in the mid-20th Century. The first two human polyomaviruses, the BK polyomavirus and JC polyomavirus, were discovered in 1971 and were shown to induce severe disease in immunocompromised patients, but their involvement in human cancers is still a matter for debate. The discovery of a polyomavirus associated with Merkel cell carcinoma (Merkel cell polyomavirus) in 2008 resulted in a renewed interest in the Polyomaviridae family, leading to the discovery of new human polyomaviruses. This review addresses the involvement of the nine human polyomaviruses and simian virus 40 in human diseases, with a particular focus on their prevalence and the humoral response directed against structural antigens in the general population and in subjects presenting specific diseases.