Clinical, Surgical, and Survival Outcomes of Periocular Merkel Cell Carcinoma: A Retrospective Cohort Analysis

Alexander L Rattunde,* Michael Gutmann,* Lukas M Möhwald, Eckart Bertelmann Department of Ophthalmology, Charité - University Medicine Berlin, Berlin, Germany*These authors contributed equally to this workCorrespondence: Alexander L Rattunde, Email [email protected]: Merkel cell carcinoma (MCC) is a rare, aggressive cutaneous malignancy with substantial risks of mortality and vision-threatening morbidity when periocular. We aimed to characterize the clinicopathologic features, management strategies, ophthalmic outcomes, and survival of periocular MCC.Methods: We conducted a retrospective cohort study of 18 periocular MCC cases treated at a tertiary center between January12010and February 1 2024. Demographic and tumor characteristics, treatment details, ocular complications, and survival endpoints were extracted from electronic records. Kaplan–Meier curves estimated overall survival (OS) and progression-free survival (PFS).Results: Eighteen patients (61% female; mean age ± SD, 71.6 ± 11.4 years) were included; 67% presented with upper-eyelid disease. Half of tumors were AJCC stage I (50.0%). Initial therapy was excision alone in 33%, excision plus radiation in 28%, and multimodal in the remainder; an average of 1.62 resections was required to achieve negative margins or functional reconstruction. Functional globe preservation was achieved in 78% of patients, with severe ocular complications in 11%. Median OS was 8.5 years (95% CI, 4.6– 12.3) and the estimated 2-year OS rate was 88.9%. Median PFS was 6.4 years (95% CI, 0.1– 12.8) with a 2-year PFS of 54.7%. Median follow-up was 17 months.Conclusion: Periocular MCC in this single-center cohort was typically detected early and managed with eye-sparing surgery with acceptable morbidity, yielding favorable OS and PFS estimates; these site-specific benchmarks can guide counseling, reconstruction, and future multicenter validation.Keywords: Merkel cell carcinoma, periocular, eyelid neoplasms, globe preservation