Mohs Surgery Early-Stage Merkel Cell Carcinoma: Is it the Best Approach?

Mohs micrographic surgery may offer a survival advantage over wide local excision for select patients with early-stage Merkel cell carcinoma (MCC), a retrospective cohort study suggested.

Mohs micrographic surgery has been found to provide a significant survival advantage compared to wide local excision for certain patients with early-stage Merkel cell carcinoma (MCC), according to a retrospective cohort study. The study, conducted over a period of 15 years and using the National Cancer Database, included over 2,000 surgical cases of MCC. The results showed that Mohs surgery was associated with a 41% reduction in the risk of death compared to wide local excision for patients with localized MCC and pathologically confirmed node-negative disease. The study authors emphasized the importance of confirming regional lymph node status, as a significant percentage of clinically node-negative cases were found to have positive sentinel lymph nodes. MCC is known to be one of the deadliest skin cancers, with a high propensity for rapid metastasis to regional lymph nodes. While surgery is considered the best treatment for localized cases, there is controversy over the optimal approach due to a lack of evidence. Current guidelines recommend Mohs micrographic surgery, wide local excision, or other forms of surgery with peripheral and deep en face margin assessment. Previous registry studies did not find a difference between Mohs and wide local excision, but these studies focused on clinically node-negative disease and likely included patients with occult nodal involvement. The present study provides preliminary data suggesting that Mohs micrographic surgery may result in optimal patient survival outcomes for this aggressive form of skin cancer. Further research is needed to evaluate outcomes after Mohs surgery with and without radiotherapy to determine if adjuvant radiation provides additional benefits. The study had limitations, including the inability to assess locoregional recurrence and disease-specific survival, the inability to control for immunosuppression status, and the small size of the Mohs micrographic surgery group. However, the findings highlight the potential benefits of Mohs surgery for select patients with early-stage MCC.