When is radiotherapy recommended for Merkel cell carcinoma?

Merkel cell carcinoma can behave aggressively, so the team reviews the primary skin tumour, nearby lymph nodes, surgical findings and any signs of spread. Radiation may be advised after removal of the skin lesion to treat the surgical area or regional nodes, particularly when local control is a concern. It can be used as a main local treatment when an operation would be difficult or cause substantial functional problems. Radiation may also relieve pain, bleeding or pressure from a deposit that cannot be removed safely.

Planning includes examination and imaging to define the skin area and drainage region. The team may use careful positioning and skin markings to cover the intended target while limiting exposure to nearby normal tissue.

Tell the oncology team about the operation, wound healing, immune treatments, medicines and skin conditions affecting the treatment area. Ask how to protect the skin from rubbing, heat and sun, and whether wound or lymphoedema support is needed. Keep the treated skin clean as instructed and report moist peeling, increasing pain or drainage early.

Seek urgent help for breathing difficulty, facial or neck swelling that worsens quickly, uncontrolled bleeding, confusion or sudden weakness. Contact the treatment team promptly for fever, spreading redness, pus, severe skin pain, or a wound that opens or stops healing.

Ask whether radiation is aimed at the primary site, lymph nodes, or both; how surgery and immune treatment fit with it; and what the expected skin reaction may look like. Ask how follow-up will examine the skin and lymph nodes and who should assess a new lump or changing lesion.