Relationships among primary tumor size, number of involved nodes, and survival for 8044 cases of Merkel cell carcinoma

Jayasri G. Iyer, Barry E. Storer, Kelly G. Paulson, Bianca Lemos, Jerri Linn Phillips, Christopher K. Bichakjian, Nathalie Zeitouni, Jeffrey E. Gershenwald, Vernon Sondak, Clark C. Otley, Siegrid S. Yu, Timothy M. Johnson, Nanette J. Liegeois, David Byrd, Arthur Sober, Paul Nghiem

Research output: Contribution to journalArticlepeer-review

78 Scopus citations


Background: The effects of primary tumor size on nodal involvement and of number of involved nodes on survival have not, to our knowledge, been examined in a national database of Merkel cell carcinoma (MCC). Objective: We sought to analyze a retrospective cohort of patients with MCC from the largest US national database to assess the relationships between these clinical parameters and survival. Methods: A total of 8044 MCC cases in the National Cancer Data Base were analyzed. Results: There was a 14% risk of regional nodal involvement for 0.5-cm tumors that increased to 25% for 1.7-cm (median-sized) tumors and to more than 36% for tumors 6 cm or larger. The number of involved nodes was strongly predictive of survival (0 nodes, 76% 5-year relative survival; 1 node, 50%; 2 nodes, 47%; 3-5 nodes, 42%; and ≥6 nodes, 24%; P < .0001 for trend). Younger and/or male patients were more likely to undergo pathological nodal evaluation. Limitations: The National Cancer Data Base does not capture disease-specific survival. Hence, relative survival was calculated by comparing overall survival with age- and sex-matched US population data. Conclusion: Pathologic nodal evaluation should be considered even for patients with small primary MCC tumors. The number of involved nodes is strongly predictive of survival and may help improve prognostic accuracy and management.

Original languageEnglish (US)
Pages (from-to)637-643
Number of pages7
JournalJournal of the American Academy of Dermatology
Issue number4
StatePublished - Apr 2014
Externally publishedYes


  • Merkel cell carcinoma
  • National Cancer Data Base
  • average tumor size
  • neuroendocrine carcinoma of the skin
  • nodal spread
  • prognosis
  • regional node metastasis
  • sentinel lymph node biopsy

ASJC Scopus subject areas

  • Dermatology


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