Selecting the Optimal Margin: Early Multidisciplinary Coordination Can Reduce Surgical Morbidity in Merkel Cell Carcinoma Management

Background/Objectives: Merkel cell carcinoma (MCC) is a rare, aggressive, cutaneous neuroendocrine cancer that requires multidisciplinary coordination to optimize patient outcomes. However, surgical decision-making still commonly occurs in isolation prior to multidisciplinary discussion, which may increase the risk of avoidable surgical morbidity. Methods: We performed a retrospective institutional review of five illustrative cases of pathologically confirmed MCC. Cases were selected to illustrate specific challenges associated with early surgical intervention without prior multidisciplinary decision-making. Results: Across the five cases, wide local excision was associated with significant morbidity, functional loss, and delays in adjuvant radiation therapy (RT) that may have been reducible through earlier multidisciplinary coordination. Several cases highlight that wider margins alone did not clearly improve locoregional control, with recurrences occurring beyond pathologically negative margins. Conclusions: These cases illustrate how surgical planning in isolation may increase morbidity and delay timely adjuvant RT without clearly improving oncologic outcomes. Early multidisciplinary discussion prior to definitive excision may permit narrower guideline-consistent margins, timely adjuvant RT, and improved functional and cosmetic outcomes. Multimodal treatment planning should be considered a cornerstone of MCC management.