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. Author manuscript; available in PMC: 2017 Nov 16.
Published in final edited form as: Curr Treat Options Oncol. 2016 Jul;17(7):36. doi: 10.1007/s11864-016-0409-1

Fig. 1.

Fig. 1

Merkel cell carcinoma general treatment algorithm. 1 Definitive treatment of primary lesion should not occur prior to SLNB. 2 Reserved for patients who are poor surgical candidates. 3 The benefit of RT to SLNB-negative basin is unclear- consider observation for low-risk patients with a small primary tumor (<1 cm); in head and neck disease, the risk of false-negative SLNB is higher. 4 PET-CT is the preferred modality; when unavailable, CT and MRI can be used. 5 NCCN guidelines recommend a clinical trial as a first-line treatment for M1 disease. 6 As clinically indicated in high-risk patients. SLNB sentinel lymph node biopsy, FNA fine needle aspiration, CLND completion lymph node dissection.