Carcinoma de células de Merkel: actualidades del abordaje quirúrgico y tratamiento multidisciplinario
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Palabras clave
Carcinoma de Células de Merkel, Radioterapia, Ganglio Linfático Centinela, Neoplasias Cutáneas
Resumen
El carcinoma de células de Merkel (CCM) es un tumor cutáneo neuroendocrino poco frecuente, agresivo y de mal pronóstico, cuyo tratamiento óptimo exige un abordaje quirúrgico preciso dentro de un marco multidisciplinario. Se realizó una revisión narrativa con búsqueda estructurada en bases de datos biomédicas (PubMed, Embase, Scopus, Web of Science) y guías oficiales (NCCN, ESMO). Se seleccionaron 30 publicaciones relevantes con base en criterios de actualidad, rigor metodológico y aplicabilidad clínica. Se encontró que la resección quirúrgica amplia con márgenes de 1 a 2 cm continúa siendo el estándar terapéutico para la enfermedad localizada. La biopsia de ganglio centinela debe realizarse en todos los casos sin afectación ganglionar clínica, y la linfadenectomía completa queda reservada para casos con confirmación patológica o sintomatología ganglionar. El tratamiento quirúrgico, aunque fundamental, resulta insuficiente si no se integra en un modelo multidisciplinario que incluya una adecuada estadificación, seguimiento oncológico e inmunoterapia en estadios avanzados. Esta revisión enfatiza el papel del cirujano como parte activa del equipo integral para mejorar la supervivencia y la calidad de vida de los pacientes con CCM.
Referencias
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