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Dear Editor,


I would like to bring to the attention of the readers a new article about Merkel cell carcinoma (MCC), which was recently published in the Journal of the American Academy of Dermatology. In the article "Pathologic Nodal Evaluation Improves Prognostic Accuracy in Merkel Cell Carcinoma: Analysis of 5823 Cases as the Basis of the First Consensus Staging System," written by Lemos et al., the authors conclude that "although the majority (68%) of patients with MCC did not undergo pathologic nodal evaluation, this procedure may by indicated in many cases as it improves prognostic accuracy" (Lemos et al., 2010, p. 751).


The authors attempted to synthesize the records of Merkel cell carcinoma from the National Cancer Data Base and, by using prognostic analysis, created a "new consensus staging system" (p. 752). This prognostic analysis was used "to derive a new MCC prognostic/staging system" (p. 752). The authors found five preexisting "conflicting" staging systems, published over the past 17 years (p. 752). In their system, the authors included the method of determining negative node status; this is the biggest discrepancy between the new system and preexisting systems. This is an important diagnostic indicator because "approximately one third of patients with MCC who undergo clinical nodal evaluation are understaged as they in fact have occult microscopic nodal involvement" (p. 760). Stated another way, according to previous studies, "approximately 1 in 3 patients with clinically node-negative MCC had microscopic nodal disease" (p. 752).


I hope this new information helps when the reader is confronted by this rare, but potentially deadly skin cancer.




Victoria Garcia-Albea, NP


The writer (nee Victoria Beebe) is the author of "A Review of Merkel Cell Carcinoma for Dermatology Nurses," Journal of the Dermatology Nurses' Association, 1(3):173-179, May/June 2009.




Lemos, B. D., Storer, B. E., Iyer, J. G., Phillips, J. L., Bichakjian, C. K., Fang, L. C., et al. (2010). Pathologic nodal evaluation improves prognostic accuracy in Merkel cell carcinoma: Analysis of 5823 cases as the basis of the first consensus staging system. Journal of the American Academy of Dermatology, 63(5), 751-761. [Context Link]