Treatment Options for Stage III Merkel Cell Carcinoma

Margin-negative local excision, attempting to maintain function.

Sentinel lymph node procedure, possibly followed by more definitive regional node surgery if positive node(s) are found.

Local and regional lymph node radiation, especially if there is concern about the adequacy of the primary tumor excision margin or the risk of local-regional recurrence following the nodal surgery (e.g., multiple primary nodes, extracapsular extension, lymphovascular invasion, and evidence of in-transit metastases).

Systemic chemotherapy and immunotherapy have been given to patients with the highest risk of recurrence, but existing data have not proven a clinical survival benefit.

Enrollment in clinical trials is encouraged.