Eur J Plast Surg (2006) 29: 107–109 DOI 10.1007/s00238-006-0047-0 ORIGINAL ARTICLE J. Liebau . A. Arens . V. Schwipper . A. Schulz Sentinel lymph node mapping for patients with Merkel cell carcinoma—experience of 5 years Received: 12 July 2005 / Accepted: 1 February 2006 / Published online: 25 July 2006 # Springer-Verlag 2006 Abstract Merkel cell carcinoma (MCC) is a rare, highly malignant carcinoma of the neuroendocrinological system (Bayrou et al., J Am Acad Dermatol 24:198–207, 1992). It is a fast-growing, aggressive tumor with a high rate of local recurrence and early metastases. A radical surgical proce- dure is the therapy of choice. In case of lymph node metastases, regional lymphadenectomy is mandatory. Sen- tinel lymph node (SLN) mapping is a standard diagnostic technique to detect micrometastases in certain patients with malignant melanoma and breast cancer. The question is, can the SLN technique provide information as a prognostic factor and can the prognosis of the MCC be improved by detecting micrometastases in SLN at an early stage? Keywords Merkel cell carcinoma . Sentinel lymph node mapping Introduction Merkel cell carcinoma (MCC) was first described by Toker in 1972 [12]. Clinically, it is a fast-growing red or blue colored skin lesion sometimes with superficial eruptions, frequently on the face of older patients (Fig. 1). Stage 1–3 is distinguished as follows: stage 1—without regional or distant metastasis, stage 1a: primary tumor less than 2 cm in diameter, stage 1b: primary tumor more than 2 cm in diameter; stage 2: locoregional metastases; and stage 3: distant metastases. It is an aggressive tumor; 15% of the patients have lymphatic metastases at the time of primary diagnosis. The local recurrence rate and the rate of lymphatic metastases are high, being 45–65% after 1 year. Retrospective literature studies of more than 400 cases showed the following factors to have a prognostic disadvantage: male sex, localization of the primary tumor to the extremities and trunk, small cell type, age less than 60 years, and metastases at time of diagnosis. Sentinel lymph node (SLN) mapping is an established method for malignant melanoma and breast cancer. The prognostic factor of SLN for MCC is discussed. Material and methods From 1986 to 2004, 152 patients with MCC stage 1–3 were treated in our clinic. The patients’ age was 37–96, the average being 69.3 years. From 1999 to 2004, 12 patients with stage 1 underwent SLN procedure in addition to the regular radical tumor resection with a 3-cm margin. Clinical exclusion of lymphatic metastases with ultrasound and staging examinations (abdominal ultrasound, chest X-ray) was performed initially. Eleven patients were female, and one was male. The average of age was 75 years. Seven patients had head and neck tumors (Fig. 1) and four had tumors of the upper extremities and one of the lower extremity. Results In nine out of 12 patients, SLN was negative. One patient had a locoregional recurrence, which was resected and treated with postoperative radiotherapy. In the other three patients with positive SLN, locoregional lymphadenec- tomies were performed. All three patients had regional J. Liebau . A. Arens . A. Schulz Department of Plastic Surgery, Fachklinik Hornheide at the Westfalian Wilhelms University, Dorbaumstrasse 100, 48157 Münster, Germany Present address: J. Liebau (*) Klinik für Plastische Chirurgie, Kaiserswerther Diakonie, Florence-Nightingale-Krankenhaus, Kreuzbergstrasse 79, 40489 Düsseldorf, Germany e-mail: liebau@kaiserswerther-diakonie.de V. Schwipper Department of Craniofacial Surgery, Fachklinik Hornheide Westfalian-Wilhelms-University, Münster, Germany