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Imaging of Merkel Cell Carcinoma¹

¹ From the Departments of Diagnostic Radiology (B.D.N.) and Laboratory Medicine and Pathology (A.E.M.), Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259. Presented as an education exhibit at the 2000 RSNA scientific assembly. Received July 13, 2001; revision requested August 24 and received November 1; accepted November 7. Address correspondence to B.D.N.

Merkel cell carcinoma (MCC) is a rare, highly malignant cutaneous tumor, primarily of the head and neck, that requires timely diagnosis, adequate staging, and aggressive therapy. MCC tends to be overlooked in the early stage, has a high propensity for invading local and regional nodal basins, and exhibits a high postoperative recurrence rate, with distant thoracic, abdominal, and central nervous system metastases. Conventional radiography and cross-sectional imaging show lesions similar to those originating from other small cell carcinomas. Nuclear medicine procedures such as sentinel node scintigraphy, somatostatin receptor scintigraphy, and positron emission tomography may be used to supplement judicious cross-sectional imaging evaluation, thereby adding diagnostic value in staging and providing therapeutic guidance. Ultimately, however, the diagnosis relies exclusively on pathologic findings at immunohistochemical staining and electron microscopy. The rarity of MCC and the resulting insufficient awareness of this neoplasm often delay correct identification and treatment, which essentially consists of wide-margin surgical excision of the primary tumor and local and regional radiation therapy. To date, clinical information is still insufficient to fully appreciate the role of imaging in MCC management. A better imaging algorithm is expected with increased awareness and improved clinical understanding of this uncommon skin neoplasm.

© RSNA, 2002

Index Terms: Merkel cell carcinoma, 40.39 • Radionuclide imaging, **.1216² • Radionuclide imaging, in diagnosis of neoplasms, **.1216 • Skin, CT, 40.1211 • Skin, neoplasms, **.321

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