Primary Radiation Therapy for Merkel Cell Carcinoma

Satellite lesions (stage IIIB) represent poorly contained disease, and surgery cannot ensure clear margins. The patient (1) is immune-competent, and a complete response to radiation therapy (RT) is expected with <10% risk of local recurrence (2). Therefore, we recommend RT for the primary site and satellite lesions with a 3- to 5-cm margin to 50 Gy in 25 fractions, avoiding interruptions. Given the curved target volume, we favor tangential photons (with bolus) sparing the medial aspect of the leg.

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