Clinical benefit of baseline imaging in Merkel cell carcinoma: Analysis of 584 patients

JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY

卷:84

Article

Singh, Neha¹  Alexander, Nora A.¹  Lachance, Kristina¹  Lewis, Christopher W.^1,2  McEvoy, Aubriana^1,3  Akaike, Gensuke⁴  Byrd, David⁵  Behnia, Sanaz⁴  Bhatia, Shailender⁶  Paulson, Kelly G.⁷  Nghiem, Paul^1,7 

[1] Univ Washington, Dept Med, Div Dermatol, Seattle, WA USA

[2] Northwestern Univ, Dept Phys Med & Rehabil, Evanston, IL USA

[3] Washington Univ, Sch Med, St Louis, MO 63110 USA

[4] Univ Washington, Dept Radiol, Div Nucl Med, Seattle, WA 98195 USA

[5] Univ Washington, Dept Surg, Sect Surg Oncol, Seattle, WA 98195 USA

[6] Univ Washington, Dept Med, Div Med Oncol, Seattle, WA 98104 USA

[7] Fred Hutchinson Canc Res Ctr, 1124 Columbia St, Seattle, WA 98104 USA

关键词: baseline imaging;    clinical guidelines;    CT;    distant metastasis;    MCC;    melanoma;    Merkel cell carcinoma;    nodal metastasis;    nonmelanoma skin cancer;    occult disease;    PET-CT;    scans;    sentinel lymph node biopsy;    skin cancer;    SLNB;    staging;   

DOI  :  10.1016/j.jaad.2020.07.065

来源: Elsevier

【 摘 要 】

Background: Merkel cell carcinoma (MCC) guidelines derive from melanoma and do not recommend baseline cross-sectional imaging for most patients. However, MCC is more likely to have metastasized at diagnosis than melanoma. Objective: To determine how often baseline imaging identifies clinically occult MCC in patients with newly diagnosed disease with and without palpable nodal involvement. Methods: Analysis of 584 patients with MCC with a cutaneous primary tumor, baseline imaging, no evident distant metastases, and sufficient staging data. Results: Among 492 patients with clinically uninvolved regional nodes, 13.2% had disease upstaged by imaging (8.9% in regional nodes, 4.3% in distant sites). Among 92 patients with clinically involved regional nodes, 10.8% had disease upstaged to distant metastatic disease. Large (>4 cm) and small (<1 cm) primary tumors were both frequently upstaged (29.4% and 7.8%, respectively). Patients who underwent positron emission tomography-computed tomography more often had disease upstaged (16.8% of 352), than those with computed tomography alone (6.9% of 231; P = .0006). Limitations: This was a retrospective study. Conclusions: In patients with clinically node-negative disease, baseline imaging showed occult metastatic MCC at a higher rate than reported for melanoma (13.2% vs <1%). Although imaging is already recommended for patients with clinically node-positive MCC, these data suggest that baseline imaging is also indicated for patients with clinically node-negative MCC because upstaging is frequent and markedly alters management and prognosis.

【 授权许可】

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