ReportsImmunostaining for cytokeratin 20 improves detection of micrometastatic Merkel cell carcinoma in sentinel lymph nodes☆
Section snippets
Material and methods
We searched the pathology database of University of Michigan Hospitals for patients who underwent SLNBx and local resection of their primary MCC from January 1998 to October 2000 and identified 10 consecutive patients. Clinical histories, follow-up reports from clinic visits, and pathology reports, along with hematoxylin-eosin (H&E)-stained sections and immunoperoxidase preparations of the primary tumor and SLNBxs, were retrospectively reviewed. All 10 patients had a biopsy-proven primary MCC,
Results
Table I summarizes the clinical and histopathologic findings in our patient population. Patients ranged in age from 51 to 85 years (mean, 66 years). The primary site was on an extremity in 7 (70%) cases and the head and neck in 3 (30%) cases. All 23 SLNBxs from our 10 patients were initially considered histologically tumor-free in H&E sections (Fig 1).
Discussion
The significance of SLN status in patients with MCC is unknown. However, because of the aggressive nature of metastatic MCC, lack of a clear biologic understanding of its behavior, lack of therapeutic and adjuvant trials, and lack of clear evidence-based therapeutic pathways, the desire for knowledge gained from assessment of SLN status in patients with MCC seems prudent.
Although large nodules of metastatic MCC in a lymph node are easily detected in H&E-stained sections, single cells and small
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Reprint requests: Timothy M. Johnson, MD, University of Michigan, Department of Dermatology, 1910 Taubman Center, Ann Arbor, MI 48109-0314.