Risk of ablative therapy for "elevated firm growing" lesions: Merkel cell carcinoma diagnosed after laser surgical therapy

Rosendahl, Cliff, Cameron, Alan and Zalaudek, Iris (2009) Risk of ablative therapy for "elevated firm growing" lesions: Merkel cell carcinoma diagnosed after laser surgical therapy. Dermatologic Surgery, 35 6: 1005-1008. doi:10.1111/j.1524-4725.2009.01173.x

Author Rosendahl, Cliff
Cameron, Alan
Zalaudek, Iris
Title Risk of ablative therapy for "elevated firm growing" lesions: Merkel cell carcinoma diagnosed after laser surgical therapy
Journal name Dermatologic Surgery   Check publisher's open access policy
ISSN 1076-0512
Publication date 2009-06-01
Year available 2009
Sub-type Article (original research)
DOI 10.1111/j.1524-4725.2009.01173.x
Open Access Status
Volume 35
Issue 6
Start page 1005
End page 1008
Total pages 4
Place of publication United States
Publisher Wiley Blackwell
Language eng
Abstract In the clinical assessment of melanoma, it has been proposed that Elevated, Firm and continuously Growing (‘‘EFG’’) be added to the well-known clinical ‘‘ABCD’’ rule.1 This is to improve detection of nodular melanoma, especially the amelanotic variant. Early detection of these rapidly growing lesions is essential if mortality is to be minimized. These ‘‘EFG’’ criteria will also detect other less common, aggressive skin malignancies such as Merkel cell carcinoma (MCC).2 MCC is a rare malignant primary cutaneous neoplasm with epithelial and neuroendocrine differentiation. 3 It is thought to derive from the Merkel cell, a neuroendocrine cell, first described by Friedrich Merkel in 1875.4 MCC was first reported in 1972 as trabecular carcinoma of the skin.5 Most MCCs are solitary and present as painless dome-shaped, pink nodules or plaques that may at times be ulcerated. Growth is typically rapid over a period of weeks to months. These clinical characteristics are summarized in the ‘‘EFG’’ rule, which has been primarily designed for the diagnosis of amelanotic nodular melanoma (AMM).1 Although spontaneous regression has been reported rarely,6 MCC has a high incidence of local recurrence, regional lymph node metastasis, and ultimately hematogenous or distant lymphatic spread. The tumor most frequently affects elderly patients, with a preference for the head and neck.7 Adverse prognostic factors include older age, location on the head and neck, size greater than 2 cm, immunosuppression, and advanced disease stage.8–10 Surgery has been the mainstay of treatment of primary MCC, with a 2- to 3-cm tumor-free margin recommended. This is often difficult to achieve on the head and neck, where Mohs micrographic surgery has proved to be effective.7 Recent evidence suggests that smaller margins may not necessarily compromise outcome if adjuvant radiotherapy is given.11 We present an 83-year-oldman with a rapidly growing pink nodule on his left forehead. In unusual circumstances, the lesion was initially treated using laser therapy without prior biopsy. It was subsequently diagnosed asMCC after wide excision of the treated area.
Keyword Dermatology
Q-Index Code C1
Q-Index Status Provisional Code
Grant ID V9-B05
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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Created: Thu, 03 Sep 2009, 18:02:56 EST by Mr Andrew Martlew on behalf of School of Medicine