![]() ![]() However, regional nodal status is the single most important prognostic characteristic of clinically localized MCC. This indicates that modified MMS can be applied to various regions of the body.Ī number of clinical and pathologic factors have been associated with a poor prognosis in MCC including male sex, older age, increased tumor size, and an immunocompromised state. Of the five patients who underwent modified MMS, three had MCC in the upper or lower extremity and two had MCC in the head and neck region. The observation that over half of the patients who underwent modified MMS remained well, while another died from an unrelated disease, indicates that modified MMS was superior to other surgical excision methods, at least within the limitations inherent to this study because of its small sample size. One died from a disease not related to MCC, and the other one was lost to follow-up. Of the five patients who underwent modified MMS, two remained well for 6 years or more postoperatively and one remained well through 14 months of follow-up. If the cancer extends beyond the resected tissue, additional excision is repeated until no more cancer cells are present in the margin of the surgically resected tissue. In this method, a plastic surgeon and a pathologist collaborate to perform margin-negative resection of cancer. In this study, modified MMS was performed in five patients, and was the main method for surgical excision. If the frozen biopsy results show malignancy, additional excision from that section is performed with the same procedure until cancer cells are no longer visible on the frozen biopsy. The resected section tissues are sent for frozen biopsy. All sections are then mapped and resected in order. The base of the lesion is also divided into sections, if necessary. The area between the previous resection margin and the new resection margin is divided into approximately 10 to 20 sections. ![]() In addition, a new resection margin is drawn with a width of 1–2 mm within the previous resection margin. First, WLE is performed as described above. Modified MMS combines the principles of MMS and WLE. In MMS, an average of 2–4 mm margin of clinically normal surrounding tissue is excised, and the procedure is continued until the absence of cancerous tissue is confirmed throughout the excision. WLE is an extensive excisional procedure with a 1- to 2-cm surgical resection margin that can be used for MCC treatment according to the guidelines of the National Comprehensive Cancer Network (NCCN). Our analysis investigated the frequency of each method and the final surgical margin. The surgical treatments included wide local excision (WLE), Mohs micrographic surgery (MMS), and modified MMS. However, no case studies of MCC in Asian patients have been reported since. A 2008 study presented 16 Japanese MCC patients, a 2010 study described seven Korean patients, and a 2012 study analyzed 22 Chinese patients. Although the reported incidence of MCC has increased by 8% per year between 19, cases in Asian patients have been rarely reported. Of these cases, 94.9% were white, 1.0% black, and 4.1% belonged to other races (Asian-Pacific Islander, American Indian, or other), indicating that MCC was very rare in Asian patients. According to the most recent available analysis, based on the 2011 Surveillance, Epidemiology, and End Results data in the United States, the incidence of MCC was 0.79 per 100,000. As mentioned earlier, MCC is more common in Caucasian patients, and its incidence varies across different regions of the world. The elderly and immunocompromised persons are at particularly high risk. MCC is very aggressive its mortality rate exceeds 33%, making it twice as lethal as malignant melanoma. It is rare, but is primarily found in older Caucasian patients. Merkel cell carcinoma (MCC) is a neuroendocrine trabecular cancer of the dermis, first described by Toker in 1972, that poses a significant risk of local invasion, lymph node metastasis, and distant metastasis. ![]()
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