Ganglio centinela en Carcinoma de células de Merkel
El European Journal of Cancer ha publicado un Consenso Europeo sobre diagnóstico y tratamiento de esta neoplasia, en el que leemos:
Sentinel lymph node biopsy is recommended if possible, whatever the size of the tumour. If micro-metastasis is demonstrated, a therapeutic lymph node dissection is proposed although there are no prospective studies demonstrating its benefit in the literature.
If a sentinel node biopsy cannot be performed, regional follow up with ultrasound and clinical examination every 4 months should be planned.
Summary of management recommendations on Merkel cell carcinoma (MCC) by European Dermatology Forum (EDF)–European Association of Dermato-Oncology (EADO)–European Organization for Research and Treatment of Cancer (EORTC) expert panel.
Diagnostic and staging recommendations:
_ The diagnosis of MCC is primarily based on histological and immunohistochemical features
_ A biopsy and histologic confirmation should be performed in all clinically suspicious lesions
_ The diagnosis of MCC should prompt a complete examination of the entire skin and palpation of the regional lymph nodes for nodal involvement
– Initial work up consists in ultrasound of the loco regional nodes as well as computerised tomography scanner (CT scan) or Positron Emission Tomography–Computed Tomography (PET–CT)
_ Sentinel lymph node biopsy is recommended if possible and is taken into account in the new AJCC classification
_ Surgical excision with 1–2 cm margins taking into account functional considerations in the head/neck region is recommended followed by adjuvant therapy of the tumour region
_ In case of lymph node involvement, the preferred treatment is a regional lymph node dissection. Adjuvant RT will be discussed in cases where multiple nodes are affected or if extracapsular involvement is observed
_ Satellite or in-transit metastases around the primary site should be removed surgically if a complete removal of the metastatic sites is feasible.
Electrochemotherapy or RT with or without chemotherapy may be used as an alternative option when surgery is not feasible
_ Mono or polychemotherapy can be used in metastatic MCC; however, there is no established standard regimen and responses are usually short-lived. The standard of care is enrolment in clinical trials
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