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Approximately one‐third of Merkel cell carcinoma (MCC) patients eventually develop distant metastatic disease. Little is known about whether the location of the primary lesion is predictive of initial distant metastatic site, or if survival likelihood differs depending on the metastatic site. Such data could inform imaging/surveillance practices and improve prognostic accuracy. Multivariate and competing‐risk analyses were performed on a cohort of 215 MCC patients with distant metastases, 31% of whom had two or more initial sites of distant metastasis. At time of initial distant metastasis in the 215 patients, metastatic sites (n = 305) included non‐regional lymph nodes (present in 41% of patients), skin/body wall (25%), liver (23%), bone (21%), pancreas (8%), lung (7%), and brain (5%). Among the 194 patients who presented with MCC limited to local or regional sites (stage I‐III) but who ultimately developed distant metastases, distant progression occurred in 49% by 1 year and in 80% by 2 years following initial diagnosis. Primary MCC locations differed in how likely they were to metastasize to specific organs/sites (P <.001). For example, liver metastases were far more likely from a head/neck primary (43% of 58 patients) versus a lower limb primary (5% of 39 patients; P <.0001). Skin‐only distant metastasis was associated with lower MCC‐specific mortality as compared to metastases in multiple organs/sites (HR 2.7; P =.003), in the liver (HR 2.1; P =.05), or in distant lymph nodes (HR 2.0; P =.045). These data reflect outcomes before PD1‐pathway inhibitor availability, which may positively impact survival. In conclusion, primary MCC location is associated with a pattern of distant spread, which may assist in optimizing surveillance. Because it is linked to survival, the site of initial distant metastasis should be considered when assessing prognosis. [ABSTRACT FROM AUTHOR]

Background: Merkel cell carcinoma (MCC) incidence rates are rising and strongly age-associated, relevant for an aging population.Objective: Determine MCC incidence in the United States and project incident cases through the year 2025.Methods: Registry data were obtained from the SEER-18 Database, containing 6600 MCC cases. Age- and sex-adjusted projections were generated using US census data.Results: During 2000-2013, the number of reported solid cancer cases increased 15%, melanoma cases increased 57%, and MCC cases increased 95%. In 2013, the MCC incidence rate was 0.7 cases/100,000 person-years in the United States, corresponding to 2488 cases/year. MCC incidence increased exponentially with age, from 0.1 to 1.0 to 9.8 (per 100,000 person-years) among age groups 40-44 years, 60-64 years, and ≥85 years, respectively. Due to aging of the Baby Boomer generation, US MCC incident cases are predicted to climb to 2835 cases/year in 2020 and 3284 cases/year in 2025.Limitations: We assumed that the age-adjusted incidence rate would stabilize, and thus, the number of incident cases we projected might be an underestimate.Conclusion: An aging population is driving brisk increases in the number of new MCC cases in the United States. This growing impact combined with the rapidly evolving therapeutic landscape warrants expanded awareness of MCC diagnosis and management. [ABSTRACT FROM AUTHOR]

Purpose: The role of postoperative radiation therapy (PORT) in early stage Merkel cell carcinoma (MCC) is controversial. We analyzed the role of PORT in preventing local recurrences (LR) among patients with low-risk, pathologic stage I MCC based on the location of the primary tumors: head/neck (HN) versus non-HN sites., Methods and Materials: One hundred forty-seven patients with MCC were identified that had "low risk" disease (pathologic T1 primary tumor, negative microscopic margins, negative pathologic node status, no immunosuppression or prior systemic therapy). LR was defined as tumor recurrence within 2 cm of the primary surgical bed, and its frequency was estimated with the cumulative incidence method., Results: Seventy-nine patients received PORT (30 HN, 49 non-HN) with a median dose of 50 Gy (range, 8-64 Gy) and 68 patients were treated with surgery alone (30 HN, 38 non-HN). Overall, PORT was associated with a decreased risk of LR (5-year rate: 0% vs 9.5%; P  = .004) with 6 LRs observed in the surgery alone group. Although the addition of PORT significantly reduced LR rates among patients with HN MCC (0% vs. 21%; P  = .034), no LRs were observed in patients with non-HN MCC managed with surgery alone. There was no significant difference in MCC-specific survival comparing HN versus non-HN groups, with or without PORT., Conclusions: For low-risk, pathologic stage I MCC of the extremities and trunk, excellent local control rates were achieved with surgery, and PORT is not indicated. However, PORT was associated with a significant reduction in LRs among low-risk MCC of the HN., Competing Interests: Peter H. Goff reports research funding from Gilead Sciences, Inc, the Conquer Cancer Foundation of the American Society of Clinical Oncology, and the RSNA R&E Foundation not directly related to this work. Daniel S. Hippe reports research grants from GE Health care, Philips Health care, Canon Medical Systems USA, and Siemens Healthineers. Paul Nghiem reports research funding and personal fees from EMD-Serono and Merck & Co. All research funding and personal fees are unrelated to the submitted work., (© 2023 The Authors.)

Background: Sexual harassment (SH) includes unwelcome sexual advances, requests for sexual favors, and hostile conduct that targets someone based on gender and overlaps with some types of sexual assault (SA). SH/SA in health care can occur between providers or between patient and provider. Most studies of SH in medicine focus on SH perpetrated by one health care provider against another, with very few studies examining SH from patient to provider., Objective: This study aimed to describe the prevalence and impact of SH/SA from patient to provider, with a particular focus on SH/SA experienced by dermatologists and trainees., Methods: An anonymous electronic survey was sent to professional listservs and an online forum, which included representatives from multiple institutions, practice settings, and medical specialties. Trainees and dermatologists were targeted particularly., Results: A total of 330 complete responses were included. In all, 83% of respondents reported experiencing SH from a patient. SH from a patient was more frequently reported by women compared with men (94% vs. 52%; p  = .001). Behaviors consistent with SA were experienced by 31% of respondents and were more frequently experienced by women (35% vs. 15%; p  = .001). Women were more likely to report that patient-to-provider SH contributed to burnout (33% of women vs. 9% of men; p  = .002). Female trainees were significantly more likely to have experienced SH compared with female attendings within the past year (94 of 110 trainees [86%] vs. 83 of 127 attendings [65%]; p  = .001). There was no significant difference in the proportion of women reporting ever experiencing SH when comparing dermatology and nondermatology specialties., Limitations: The limitations of this study include the relatively small sample size, oversampling of trainees, and a gender-biased sample., Conclusion: Patient-to-provider SH/SA is widespread, particularly among women and trainees, and may have a significant impact on burnout., (© 2020 Published by Elsevier Inc. on behalf of Women's Dermatologic Society.)