Survival outcomes after Mohs micrographic surgery are equivalent to wide local excision for treatment of Merkel cell carcinoma of the head and neck

October 11, 2023


Archives of dermatological research

Publication Date

October 11, 2023


Pearlman, R. L., O'Hern, K. J., Demer, A. M., Zeng, C., & Liszewski, W. Summary

When treating Merkel cell carcinoma (MCC) that hasn’t spread beyond the primary site yet, doctors often use surgery, but the best type of surgery is unclear. These authors looked at two types of surgery: one where they remove thin layers of skin and check them under a microscope during the surgery to ensure no cancer cells remains (Mohs surgery) and another where they remove the visible tumor and some normal skin around it to remove possible ‘non-visible’ cancer cells around the tumor (wide local excision or WLE). The study investigated which of these surgeries seems to lead to better outcomes in MCC of the head and neck. They found that for the patients in their study, there was no significant difference in the risk of recurrence for patients who received Mohs vs WLE, indicating that these two options may be safely used in treating head and neck MCCs, assuming that a sentinel lymph node biopsy will be performed as well.


Optimizing treatment algorithms for Merkel cell carcinoma (MCC) is challenging due to its relative rarity, and current guidelines are often insufficient for managing individual patient cases. Surgery is usually the first step in management of localized MCC. However, the optimal surgical approach remains unclear. Both wide local excision (WLE) and Mohs micrographic surgery (MMS) are effective for primary tumor extirpation with or without adjuvant radiation or sentinel lymph node biopsy [1]. Prior data from the National Cancer Database (NCDB) suggest that treatment with either MMS or WLE produce similar survival outcomes for stage I and II tumors on all anatomic sites [2]. Recent data have demonstrated that there is a survival benefit for MMS over WLE for head/neck melanoma [3]. We sought to determine if a similar survival benefit exists when exclusively considering MMC of the head/neck. We performed an updated retrospective analysis of the NCDB including all patients with head and neck MCC treated with surgery between 2004 and 2015.

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