Neoadjuvant Checkpoint Inhibitor Therapy for Merkel Cell Carcinoma.

Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Andrew S Brohl, Vernon K Sondak

Abstract

A 78-year-old man presented with rapidly enlarging lymph nodes in the right preauricular region and neck. Needle biopsy revealed a cytokeratin 20-positive, high-grade neuroendocrine neoplasm consistent with Merkel cell carcinoma (MCC). Cross-sectional imaging disclosed a 5.2-cm intraparotid mass and extensive adenopathy in the ipsilateral cervical and submental chains (Figs 1A and 1C), without distant metastatic disease. A skin examination did not reveal a primary lesion (hence, stage IIIA, T0N1bM0). The patient's history was notable for hypertension, diet-controlled diabetes type II, high cholesterol, and a past history of numerous cutaneous basal and squamous cell carcinomas. He was quite active but reported discomfort from the bulk of the tumors. The patient was evaluated by the surgical oncology team, who believed that the parotid mass and cervical adenopathy were technically resectable but that resection carried a substantial risk of morbidity because of the potential need to sacrifice the facial and/or spinal accessory nerves and because of a likely margin-positive (R1 or R2) result. He was referred to the medical oncology team to discuss management options for regionally advanced, "borderline-resectable" MCC.

References

Jan 25, 2012·Annals of Surgical Oncology·Jeremiah L DeneveJonathan S Zager
Sep 19, 2014·World Journal of Gastrointestinal Oncology·Ambedkar Raj Kulandai VeluIlavarasi Sinduja
Dec 5, 2014·JAMA Otolaryngology-- Head & Neck Surgery·Michelle M ChenBenjamin L Judson
Feb 7, 2019·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Paul NghiemSuzanne L Topalian
May 14, 2019·Surgical Oncology Clinics of North America·Luke D RothermelVernon K Sondak
Aug 11, 2019·Clinical Cancer Research : an Official Journal of the American Association for Cancer Research·Todd C KnepperAndrew S Brohl
Feb 28, 2020·Annals of Surgical Oncology·C R FarleyM C Lowe
Apr 24, 2020·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Suzanne L TopalianPaul Nghiem

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