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• W2171072925 abstract "We read with interest the publication by Missotten et al1Missotten G.S. de Wolff-Rouendaal D. de Keizer R.J.W. Merkel cell carcinoma of the eyelid: Review of the literature and report of patients with Merkel cell carcinoma showing spontaneous regression.Ophthalmology. 2008; 115: 195-201Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar about spontaneous regression of Merkel cell carcinoma (MCC). However, we have doubts whether the suggestion of spontaneous regression is correct. In our view, the spontaneous regression of these tumors suggests no recurrence without any therapeutic influence. The diagnosis of tumor is based on histology and immunohistochemistry. In some cases of small MCC alone, the tumor biopsy can remove all mitotically active cells. In this special situation, the remaining mature cells will not divide. The authors did not use fine-needle aspirates. In our experience of the 4 published MCC cases with a long follow-up of 9 years, only 1 case had no recurrence2Holak H. Weber U. Holak N. Donhuijsen K. Neuroendocrine tumors of visual system-Merkel cell carcinoma.Klin Oczna. 2003; 105: 362-366PubMed Google Scholar (the mean follow-up in the authors' report was 50 months). This may depend on the localization and art of spreading of MCC. Although the tumor biopsy was carried out in all published cases of spontaneous regression of MCC,1Missotten G.S. de Wolff-Rouendaal D. de Keizer R.J.W. Merkel cell carcinoma of the eyelid: Review of the literature and report of patients with Merkel cell carcinoma showing spontaneous regression.Ophthalmology. 2008; 115: 195-201Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar, 3Brown T.J. Jackson B.A. Macfarlane D.F. Goldberg F.H. Merkel cell carcinoma: spontaneous resolution and management of metastatic disease.Dermatol Surg. 1999; 25: 23-25Crossref PubMed Scopus (43) Google Scholar, 4Junquera L. Torre A. Vicente J.C. Garcia-Consuegra L. Fresno M.F. Complete spontaneous regression of Merkel cell carcinoma.Ann Rhinol Laryngol. 2005; 114: 376-380Crossref PubMed Scopus (36) Google Scholar, 5Kayashima K. Ono T. Joho Y. et al.Spontaneous regression in Merkell cell (neuroendocrine) carcinoma of the skin.Arch Dermatol. 1991; 127: 550-553Crossref PubMed Scopus (76) Google Scholar, 6Vesely M.J. Murray D.J. Neligan P.C. Novak C.B. Gullane P.J. Ghazarian D. Complete spontaneous regression in Merkel cell carcinoma.J Plast Resonstr Aesthet Surg. 2008; 61: 165-171Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar we would suggest using the term “regression” after biopsy or minisurgery. In most cases the MCC is localized in the upper lid region. Therefore, the tumor spreading could be hindered by the tarsus. After a resection of the MCC in this area—cases 2 and 3 published in the article by Missotten et al, or case 1 published in our article—the tumor recurrence did not occur.1Missotten G.S. de Wolff-Rouendaal D. de Keizer R.J.W. Merkel cell carcinoma of the eyelid: Review of the literature and report of patients with Merkel cell carcinoma showing spontaneous regression.Ophthalmology. 2008; 115: 195-201Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar, 2Holak H. Weber U. Holak N. Donhuijsen K. Neuroendocrine tumors of visual system-Merkel cell carcinoma.Klin Oczna. 2003; 105: 362-366PubMed Google Scholar We suggest that the resection of the whole active tumor was the main reason of no recurrence in these cases. If some mitotically active parts of the MCC are left, the tumor will spread again. Resection with superficial adjacent tarsus seems to be satisfactory for small MCC. On the other hand, if the tumor is already deeply spread in lymphatic vessels of the eyelid or brow area, as in our cases 3 and 4, the MCC has greater tendency for metastasis. In this case, even extensive resection and chemotherapy have not been successful.2Holak H. Weber U. Holak N. Donhuijsen K. Neuroendocrine tumors of visual system-Merkel cell carcinoma.Klin Oczna. 2003; 105: 362-366PubMed Google Scholar Author replyOphthalmologyVol. 115Issue 9PreviewWe thank Drs Holak and Holak for their positive comment on our article. They raise the question whether the regression of Merkel cell carcinoma (MCC) is spontaneous or biopsy induced. Spontaneous regression has been suggested in MCC at other locations by the fact that MCC metastases can be found without a sign of a primary MCC tumor in 15% to 20% of cases1 and by clinical observations without biopsy.2 Also, large zones of necrosis are found in some MCC biopsies. In our second case, 2 biopsies were taken with an interval of 2.5 months, both positive for MCC cells and with active cells reaching into the margins. Full-Text PDF" @default.
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• W2171072925 title "Merkel Cell Carcinoma" @default.
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