Consider Surgery, but Not in This Case

We lack clear data regarding best management of Merkel cell carcinoma (MCC) with satellite metastases, given the rarity of presentation. Although wide excision for primary MCC is the standard of care, we advise against surgery here (1) because of the high probability that subclinical satellite metastases will prevent clear margins. Because MCC is highly sensitive to radiation therapy (RT), the added morbidity of surgery here is unlikely to provide further benefit. Radiation therapy fields would include the known primary and satellite lesions with a 5-cm margin, to a total dose of 50 to 60 Gy over 5 to 6 weeks (2 Gy/d) (2).

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