Lymph Node Procedures of the Head and Neck
Likely due to the increased propensity for sun exposure, the head and neck is the most common place to develop Merkel cell carcinoma (MCC). Combined with the aggressive nature of the disease and proclivity of locoregional/distant spread, the lymphatic-ric
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Lymph Node Procedures of the Head and Neck Chase M. Heaton and Steven J. Wang
Introduction and History The head and neck is the most common location to diagnose Merkel cell carcinoma (MCC) with a reported incidence of 30–50 % of all cases found there due to the fact that the disease has a predilection to occur on sun-exposed skin [1, 2]. However, up to 5 % of disease can be located on mucous membranes as well [3]. As when seen in other locations throughout the body, MCC tends to present in the seventh or eighth decade of life, most frequently in the elderly and those who are immunosuppressed. With its aggressive behavior and potential for primary site recurrence, locoregional spread, and distant metastasis, diagnosis and treatment should be paramount when MCC occurs in this lymphatic-rich location.
Epidemiology Within the head and neck, epidemiological traits of MCC parallel those of the disease in other locations throughout the body with an increasing C.M. Heaton Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, 2233 Post Street, 3rd Floor, San Francisco, CA 94115, USA e-mail: [email protected] S.J. Wang (*) Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, 2380 Sutter Street, Box 1703, San Francisco, CA 94115, USA e-mail: [email protected]
incidence. Roughly 1,500 cases of MCC in all sites are diagnosed yearly with up to 50 % of lesions located on the head neck. It has a predilection for men with a reported predominance of 1.1–2.5:1; and by race, nearly all cases are in Caucasians [4–6]. Rarely does the disease manifest at ages younger than 65 with most lesions identified in patients greater than 75 [3]. As previously mentioned, MCC has a predilection for sun-exposed skin. Agelli demonstrated a higher incidence of MCC in climates with more sun exposure by noting differences in MCC incidence within cities of varying ultraviolet B (UVB) indices [4]. From these findings, the most common patient presentation is an elderly Caucasian male with a history of sun exposure. Immunosuppression also increases the risk of developing MCC. Studies have shown a nearly eightfold increase in risk HIV patients and tenfold increase risk in organ transplant patients [7, 8]. There is also a predilection for earlier development of MCC in this patient population, with one study showing nearly 30 % of cases diagnosed before the age of 50 [8].
Risk Factors MCC of the head and neck shares the same risk factors as with the disease seen in other parts of the body. Both UVB exposure and immunosuppression, whether acquired as in HIV or iatrogenic in the immunosuppressed transplant patient, appear to be independent risk factors for the
M. Alam et al. (eds.), Merkel Cell Carcinoma, DOI 10.1007/978-1-4614-6608-6_7, © Springer Science+Business Media New York 2013
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development of MCC. There is also a growing suspicion of a suspected viral etiology for the disease. A recently discovered polyomavirus, appropriately p
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