Likely due to the increased propensity for sun exposure, the head and neck is the most common place to develop Merkel cell carcinoma (MCC). Combined with the aggressive nature of the disease and proclivity of locoregional/distant spread, the lymphatic-rich area of the head and neck makes early diagnosis and treatment of MCC in this region paramount. Within the head and neck, MCC is often found on the most sun-exposed areas. However, a thorough oral and nasal exam is necessary to determine the presence of synchronous lesions on mucous membranes. Other cancerous lesions, including basal and squamous cell carcinoma, may also be present and should be identified. Sentinel lymph node biopsy has become a valuable tool in the staging of head and neck MCC. A thorough preoperative discussion should be conducted with the patient regarding the logistics of the procedure and potential treatment options available. When situated on the head or neck, excision of the primary lesion makes for a formidable challenge of reconstruction. While the primary goal is complete surgical removal of disease with negative margins, the secondary goal is to preserve the function and aesthetic of the face. Surgeons should be considerate of these fundamental tenants when developing their operative plan. While occasionally still performed, lymphadenectomy procedures are less commonly used as a means to cure patients of locoregional disease. Studies have supported the role of adjuvant radiotherapy to local nodal beds to suppress lymphatic spread and increase disease-free survival.
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