No clear winner between the main operations
The review's central message is that the published evidence does not show whether digit-preserving wide local excision, or WLE, is better than ray amputation for Merkel cell carcinoma affecting the digits, hand or wrist. The authors describe the findings as descriptive and hypothesis-generating rather than comparative or causal.
Among 25 individually reported digital cases, 15, or 60%, were treated with digit-preserving WLE and 10, or 40%, with ray amputation. Those figures show how the published cases were managed, not which operation produces better outcomes.
Among digital cases with recurrence data, recurrence was reported in 2 of 7 WLE cases, or 29%, and 2 of 8 ray-amputation cases, or 25%. Merkel cell carcinoma-related mortality was reported in 2 of 9 cases, or 22%, in each treatment group. The denominators are smaller than the 25 digital cases because outcome data were not available for everyone.
The hand and wrist reports were thinner
The hand and wrist evidence leaned heavily toward WLE. It was used in 17 of 19 cases, or 89%, while Mohs micrographic surgery was used in 2 cases, or 11%.
The outcomes were also incomplete. Among hand and wrist cases with available data, recurrence was reported in 7 of 14 cases, or 50%, and Merkel cell carcinoma-related mortality in 2 of 12, or 17%. These proportions are descriptive because the underlying reports did not provide outcome data for every case.
Additional treatment varied. In digital cases, sentinel node biopsy was reported in 9 patients, or 36%, nodal dissection in 8, or 32%, radiotherapy in 10, or 40%, and chemotherapy in one, or 4%. Nodal management was not reported for 8 digital cases, or 32%. Among hand and wrist cases, radiotherapy was used in 10 of 19, or 53%, and chemotherapy in 4 of 19, or 21%. Of the 13 cases with reported nodal management, 5, or 38%, had sentinel node biopsy and 4, or 31%, had nodal dissection.
A broader cohort still left gaps
A separate group of 25 hand and wrist patients was reported as a whole and kept separate from the individually reported cases. Recurrence occurred in 11 of 25 patients, or 44%, and 11 of 25 died during follow-up. At five years, the reported recurrence-free survival figure was 54.8% and the disease-specific survival figure was 67.6%.
That cohort also reported a mean upper-extremity Musculoskeletal Tumor Society score of 25.3 six months after surgery, with scores ranging from 17 to 30. The score was not reported by procedure, and none of the individually reported cases had a validated functional outcome measure.
The same reporting gaps appeared in the surgery itself. Across 44 individually reported cases, a planned excision margin was stated in 10, while five final margins were positive. Functional measures were not described and complications were not systematically reported.
A map of the evidence, not a verdict
To assemble the review, researchers searched MEDLINE and Embase via Ovid through April 2024, updated the search in July 2026 and manually screened reference lists. Grey literature was not searched. The search yielded 642 articles; 135 full texts were read, and 42 observational studies were included. These comprised 33 case reports, 6 case series and 3 retrospective observational studies. No prospective or randomized study was identified.
The review did not pool the results because the studies differed in their populations, treatments and outcome reporting. Instead, it used descriptive counts and proportions among cases with available data. That approach can show what was reported, but it cannot establish that one treatment caused better or worse outcomes.
The result is an uneven evidence base rather than a treatment verdict. The authors' strongest conclusion is that the findings remain descriptive and hypothesis-generating, so the review does not establish which operation is best.
Paper data and sources
Original title: Management of Merkel Cell Carcinoma of the Digits, Hand, and Wrist La prise en charge du carcinome à cellules de Merkel des doigts, de la main et du poignet
Authors: Raman K, Thareja R, Bensimon G et al.
Journal/Repository: Plastic Surgery
Status: Peer-reviewed
First online: 2026-10-13
DOI: Not available
Original paper · Full text