Joshua A Kent, Kelvin Anderson, Christine R Burton, Preethi Mozhiyil Chathoth, S Lynn Sigurdson, William J Magner, Gyorgy Paragh, Vishal Gupta
Merkel cell carcinoma of the cheek is associated with increased parotid involvement, higher rates of nodal metastasis compared with other head and neck subsites, and cheek location was an independent predictor of nodal positivity. These findings suggest that anatomic subsite may influence disease behavior and highlight the need for larger studies to determine whether subsite-specific management strategies are warranted.
BACKGROUND: Merkel cell carcinoma (MCC) is a rare and highly aggressive neuroendocrine tumor that frequently arises in the head and neck region. While known risk factors include advanced age, Merkel cell polyomavirus infection, immunodeficiency, and ultraviolet exposure, the impact of anatomic subsite on disease behavior and prognosis remains poorly defined.
METHODS: We performed a retrospective cohort study of 46 patients with head and neck MCC treated by head and neck surgeons at Roswell Park Comprehensive Cancer Center between 2008 and 2022. Patients were identified using ICD-9 and ICD-10 codes. Clinical staging, pathologic findings, treatment modalities, recurrence rates, and survival outcomes were analyzed. Recurrence-free survival and overall survival were evaluated using Kaplan-Meier analysis.
RESULTS: Among 46 patients with head and neck MCC, the cheek was the most common subsite (39.1%). Cheek MCC was associated with significantly higher rates of parotid involvement and lymph node metastasis compared with other subsites (69.2% vs. 25%, Fisher p = 0.03). In multivariable analysis adjusting for age and immunosuppression, cheek location was an independent predictor of nodal positivity (adjusted odds ratio [OR] 7.4, 95% confidence interval [CI] 1.4-41.0, p = 0.02). Among patients who recurred, cheek primaries tended to recur earlier (median 4 vs. 12 months), though this trend was not statistically significant. No statistically significant difference was observed in 3-year overall or recurrence-free survival across subsites on Kaplan-Meier analysis.
CONCLUSIONS: Merkel cell carcinoma of the cheek is associated with increased parotid involvement, higher rates of nodal metastasis compared with other head and neck subsites, and cheek location was an independent predictor of nodal positivity. These findings suggest that anatomic subsite may influence disease behavior and highlight the need for larger studies to determine whether subsite-specific management strategies are warranted.