Merkel cell carcinomas are first treated with wide local excision (removal of the cancer and a wide margin of normal skin) or Mohs surgery.
These cancers have a tendency to spread to the lymph nodes or distant sites. So even if the lymph nodes do not seem enlarged, many doctors recommend a sentinel lymph node biopsy to look for possible spread of cancer to the lymph nodes. For this procedure, the lymph node that would most likely contain cancer if it has spread (known as the sentinel node) is removed and looked at. When possible, this should be done before surgery to the skin. If the sentinel node contains cancer, a full lymph node dissection (removal of all of the nearby nodes) is usually done. In either case, radiation therapy to the affected area after surgery is often used to reduce the risk of cancer coming back. If many lymph nodes were found to contain cancer cells, adjuvant (additional) chemotherapy may be recommended as well.
If nearby lymph nodes are enlarged at the time the cancer is diagnosed, a fine needle aspiration (FNA) biopsy may be done to determine if they contain cancer. If cancer is found, treatment options include a lymph node dissection, radiation therapy to the area, or a combination of the two. Adjuvant treatment with chemotherapy may also be considered.
For cancers that have spread to or recur in distant sites, surgery, radiation therapy, chemotherapy, or some combination of these treatments may be used. These treatments may relieve symptoms or shrink these cancers for a time, but they rarely cure Merkel cell carcinoma that has spread beyond the skin.
Overall, the 5-year survival rate (the percentage of patients who live at least 5 years after diagnosis) for Merkel cell carcinoma is about 60%. It is much higher if the cancer is found early as opposed to having spread to the lymph nodes or distant parts of the body.
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