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Advanced Merkel cell carcinoma of the lower extremity treated with surgery and isolated pelvic and limb perfusion using Melphalan: A case of unexpected long-term survival
- Source :
- International Journal of Surgery Case Reports
- Publication Year :
- 2019
-
Abstract
- Highlights • Merkel cell carcinoma is a rare and aggressive skin cancer. • We report the case of a female patient with recurrent MCC of the leg. • The patient was not eligible for immunotherapy, systemic chemotherapy and radiotherapy. • The patient received repeated surgical excisions combined with Melphalan IPLPs with unexpected long-term survival.<br />Introduction Merkel cell carcinoma (MCC) is a rare, neuroendocrine skin tumor, with high frequency of locoregional recurrence, metastases, and poor prognosis. Locoregional MCC recurrence in the extremities can pose considerable treatment challenges. We report a case of long-term survival in a female patient with recurrent MCC of the leg, treated with surgery and locoregional chemotherapy. Presentation of case A 73-year-old female with cirrhosis and hepatitis C, developed cutaneous MCC in the left inferior limb. This patient initially received surgical treatment, with subsequent negative sentinel lymph-node biopsy in another center, one-month prior recovery in our department, and arrived with 4 new limb nodules, cranially to the previously treated area, without distant metastases or inguinal lymph node recurrence. This patient was not eligible for immunotherapy due to active hepatitis upon treatment with NS5B inhibitors, or eligible for systemic chemotherapy or radiotherapy due to severe neutropenia and was, therefore, subjected to surgical resection combined with Isolated Pelvic and Limb Perfusion (IPLP) with Melphalan. Histological evaluation confirmed MCC diagnosis and during the following 4 months, she developed further locoregional recurrences with homolateral inguinal lymph node involvement and was subjected to two additional rounds of surgery plus IPLP. Discussion All procedures were tolerated, systemic toxicities were temporary and subsequent clinical and radiological follow-up, following the last combined treatment, indicated that this patient was still alive and disease-free, at 56 months. Conclusion In this case, surgery combined with locoregional Melphalan chemotherapy was an effective and repeatable treatment for recurrent MMC and resulted in unexpected long-term survival.
- Subjects :
- Melphalan
medicine.medical_specialty
Cirrhosis
medicine.medical_treatment
Case report
In-transit metastases
Isolated pelvic and limb perfusion
Merkel cell carcinoma
Merkel cell polyoma virus
Article
03 medical and health sciences
0302 clinical medicine
Biopsy
medicine
Limb perfusion
Chemotherapy
integumentary system
medicine.diagnostic_test
business.industry
Hepatitis C
medicine.disease
Surgery
Radiation therapy
030220 oncology & carcinogenesis
030211 gastroenterology & hepatology
business
medicine.drug
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- International Journal of Surgery Case Reports
- Accession number :
- edsair.doi.dedup.....42ea39db0cb9b4a317456a32b9f355aa