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Same-Day Coordination of Mohs Surgery, Lymphoscintigraphy, and Sentinel Lymph Node Biopsy for Merkel Cell Carcinoma: A Single-Center Feasibility Report
by
, ,
Victoria H. Ruesch
1,*,†
,
Justin Thrush
2,†,
James F. Bena
3,
Claudia Ricotti
2,
Melissa Piliang
2,
Melissa McEnery-Stonelake
2,
Basia Marie Michalski-McNeely
4,
Jon Meine
2,
Jennifer Lucas
2,
Christine Poblete-Lopez
2,
Shlomo Koyfman
5,
Brian Gastman
6,‡ and
Allison T. Vidimos
2,*,‡ 1
School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
2
Department of Dermatology, Cleveland Clinic, Cleveland, OH 44195, USA
3
Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH 44196, USA
4
Department of Dermatology, Washington University in St. Louis, St. Louis, MO 63130, USA
5
Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH 44195, USA
6
Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH 44106, USA
*
Authors to whom correspondence should be addressed.
†
These authors contributed equally to this work.
‡
These authors also contributed equally to this work.
Cancers 2026, 18(19), 3187; https://doi.org/10.3390/cancers18193187
Submission received: 2 August 2026
/
Revised: 29 September 2026
/
Accepted: 1 October 2026
/
Published: 2 October 2026
(This article belongs to the Special Issue Recent Advances in Diagnosis and Therapy of Skin Cancers)
Simple Summary
In this study, we aimed to test our protocol for the treatment of Merkel cell carcinoma (MCC). Our protocol involves coordination with the Department of Dermatology, the Department of Plastic Surgery, and the Department of Nuclear Medicine so that both Mohs surgery and lymph node biopsy are completed on the same day. We did not detect differences in most outcomes between the two protocols, although the study was small and follow-up was limited. Our findings suggest the same-day protocol is logistically feasible and warrants prospective study.
Abstract
Background/Objectives: Merkel cell carcinoma (MCC) is an aggressive neuroendocrine tumor, most commonly occurring on the head and neck. Incidence of MCC is rising with the aging population. Five-year overall survival (OS) for localized MCC is 50.6%; 5-year OS for patients with distant metastases is 13.5%. The purpose of this study is to determine if coordination of care for the treatment of MCC is logistically feasible, and provide a description of the patient population observed at this institution. Methods: All patients with MCC diagnosis from January 2012–June 2024 were identified at our tertiary care center. All patients with MCC were added to our non-melanoma skin cancer registry. Outcomes were compared between those treated with our “Merkel cell carcinoma in a day” (MIAD) protocol and those receiving the standard treatment protocol. Results: No significant differences were detected in the recurrence rate, transit metastasis, distant metastasis, and disease-specific death. Nodal metastasis was higher in the MIAD group (HR 4.94, 95% CI 1.08–22.6, p = 0.039, six events total). Both groups had similar times to treatment and treatment within 30 days of diagnosis. Conclusions: MCC is a rare and aggressive tumor, often exhibiting subclinical tumor spread. Mohs micrographic surgery ensures 100% peripheral and deep margin assessment, with potential for tissue sparing. With thoughtful coordination, lymphoscintigraphy can be completed on the same day as Mohs surgery followed by sentinel lymph node biopsy (SLNB) and reconstructive surgery.
