Merkel cell carcinoma is an aggressive tumor that should be treated early and aggressively. Although there are 5 published cases of spontaneous regression of Merkel cell carcinoma, a patient's best chance for survival is early detection with either wide local excision or Mohs' micrographically controlled margins with a final 5- to 10-mm layer. This should be followed by sentinel lymph node biopsy with lymph node dissection of the draining basin if metastases are discovered. Adjuvant radiation to the primary site and the draining basin should follow. Although this aggressive approach to treatment is not appropriate for every case, the literature, although scanty, supports this. Chemotherapy with or without additional radiation therapy should be offered to patients with advanced disease, mostly for palliation. The need for prospective trials and longer follow-up for larger series of patients is obvious.
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