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    Merkel Cell Carcinoma Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Stage Information for Merkel Cell Carcinoma

    Previously, five competing staging systems have been used to describe Merkel cell carcinoma (MCC) in most publications.

    Table 2. Five Previously Used Competing Merkel Cell Carcinoma Staging Systems

    First Author Publication Date Institution(s) No. of Patients in Case Series Dates of Cases
    MSKCC = Memorial Sloan Kettering Cancer Center; N/A = Not applicable.
    a The MSKCC system has evolved over time. MSKCC authors have published one additional case series with 256 patients.[1]
    Yiengpruksawan et al.[2] 1991 MSKCCa 77 1969-1989
    Allen et al.[3] 1999 MSKCCa 102 1969-1996
    Allen et al.[4] 2005 MSKCCa 250 1970-2002
    American Joint Committee on Cancer[5] 2002 N/A N/A
    Clark et al.[6] 2007 Westmead Hospital, Sydney, Australia 110
    Princess Margaret Hospital/University Health Network, Toronto, Canada
    Sydney Head and Neck Cancer Institute/Royal Prince Alfred Hospital, Sydney, Australia

    These staging systems are highly inconsistent with each other. Indeed, stage III disease can mean anything from advanced local disease to nodal disease to distant metastatic disease. Furthermore, all MCC staging systems in use have been based on fewer than 300 patients.

    Definitions of TNM

    To address these concerns, a new MCC-specific consensus staging system was developed by the American Joint Committee on Cancer (AJCC) to define Merkel cell carcinoma, as shown in tables 3, 4, 5, and 6.[7] Prior to the publication of this new system, the AJCC advocated using the nonmelanoma staging system.

    Table 3. Primary Tumor (T)a

    a Reprinted with permission from AJCC: Merkel cell carcinoma. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 315-23.
    TX Primary tumor cannot be assessed.
    T0 No evidence of primary tumor (e.g., nodal/metastatic presentation without associated primary).
    Tis In situ primary tumor.
    T1 ≤2 cm maximum tumor dimension.
    T2 >2 cm but ≤5 cm maximum tumor dimension.
    T3 >5 cm maximum tumor dimension.
    T4 Primary tumor invades bone, muscle, fascia, or cartilage.
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