Surgical Management of Merkel Cell Carcinoma

Merkel cell carcinoma (MCC) is a rare but highly aggressive skin cancer with a high mortality rate. Surgery is the cornerstone of treatment for localized disease. National Comprehensive Cancer Network (NCCN) guidelines recommend wide local excision (WLE) with 1–2 cm margins, narrow-margin excision (NME) followed by radiation therapy (RT), or Mohs micrographic surgery (MMS). A sentinel lymph node biopsy (SLNB) is advised for all surgical candidates, as lymph node spread is common. Studies show mixed results comparing WLE and MMS—both achieve similar survival outcomes, though MMS offers complete margin evaluation and may reduce the need for RT in some cases. While MMS is less commonly performed for MCC, emerging evidence suggests it may lower recurrence and improve survival in select patients, particularly when SLNB is done first. Current practice trends still favor WLE, but MMS remains an important option, especially for tumors in cosmetically sensitive areas.

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