Merkel cell carcinoma in South East Scotland, 1993– 2003

Background and Aims: Merkel cell carcinoma (MCC) is a rare cutaneous malignancy. The aims of this study were to look at the incidence and distribution of MCC in a predominantly skin type I Caucasian population, review overall management of the disease and assess patient outcomes. Methods: Cases were identified through the regional pathology database. Twenty patients were diagnosed with MCC over a 10-year period (1993–2003) and managed at the Regional Plastic Surgery Unit at St John's Hospital, Livingston. Results: The disease incidence was found to be 0.133 per 100,000 per annum. All patients were Caucasian, seven males and 13 females (1: 1.9 ratio). The mean age at presentation was 77 years (range 58–93 years). The majority of lesions were found to be stage IA (80%), located in the head and neck region. There were two cases (10%) with stage II disease and two (10%) with stage III disease (both with liver metastases) at the time of diagnosis. All patients were managed operatively. Seventeen of the 20 had wide local excisions; of the remaining three, two were only suitable for debulking procedures and one patient (stage II) had only a diagnostic biopsy, refusing intervention thereafter. One patient received adjuvant chemoradiotherapy. Conclusion: Surgery remains the mainstay of treatment but adjuvant therapy, in particular chemotherapy, is problematic in a frail, elderly population