Merkel cell tumours are rare, aggressive and potentially lethal dermal malignant tumours. The primary treatment of this lesion is surgical excision. However, the exact free margin remains undecided and immediate use of adjuvant therapy is still controversial.

A retrospective review of 53 cases attending Christie Hospital (regional cancer unit in Northwest region of England, UK) over the last 20 years (1982-2002) was carried out. Histopathology reports, clinical case notes and current literature were reviewed in detail.

The demographic details were as follows: age range 17-92 years (median 78 years SD= 14.9 years), and 23 males and 30 females. The maximum diameter of the tumour varied form 0.5- 9 cm. There were 30 cases (57 %) with tumour in the head and neck region; 4 (8 %) in the trunk; 5 (9 %) in the upper limb and 14 (26 %) in the lower limb. There were variable excision margins between 1-3 cm depending on the anatomical site of the tumour. 7 cases (14 %) had locoregional lymphadenopathy at the time of first presentation. 13 cases (25 %) had radiotherapy and 4 cases (8 %) had chemotherapy at the time of primary treatment. Primary adjuvant therapy was given for incomplete excisions and nodal involvement not treated surgically. 35 cases (66 %) had locoregional recurrence presenting between 3 months to 3 years. 29 cases (55 %) had secondary radiotherapy and others were treated with a combination of wide local excision and chemotherapy. At 1, 2, 3, 4, and 5 year follow-up, the survival rates were 28 %, 17 %, 15 %, 15 %, and 13 %.

Merkel cell tumours are highly malignant and potentially lethal. We have reviewed a large case series (one of the largest in the literature) and offer an algorithm based on our experience for optimal management of this condition. We believe that aggressive primary treatment and adjuvant radiotherapy may improve the outcome of this disease.