Biopsy of any suspicious lesion at the primary site confirms local recurrence. If recurrence is present, treatment involves reexcision with a 2-cm margin or with Mohs micrographic surgery. Use further radiotherapy, if possible. Biopsy of suspicious nodes confirms regional recurrence. If present, treatment includes redissection of the lymph node basin and further radiotherapy, if possible.
Adjuvant chemotherapy is used in event of regional recurrence.
Responses have occurred, although no survival benefit has been proven in the small number of patients studied. The prognosis in such patients is very poor with a mean survival time of 8 months. MCC is a chemosensitive tumor. Since MCC is histochemically similar to small cell carcinoma of the lung, the chemotherapeutic regimens are similar. Most recently, carboplatin and etoposide have shown the most promising results with the least toxicity.