{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T05:46:53Z","timestamp":1777441613189,"version":"3.51.4"},"reference-count":42,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2020,10,20]],"date-time":"2020-10-20T00:00:00Z","timestamp":1603152000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100005326","name":"yale university","doi-asserted-by":"publisher","award":["William U. Gardner Memorial Student ResearchFellowship at the Yale University School of Medicine"],"award-info":[{"award-number":["William U. Gardner Memorial Student ResearchFellowship at the Yale University School of Medicine"]}],"id":[{"id":"10.13039\/100005326","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010900","name":"yale cancer center","doi-asserted-by":"publisher","award":["Yale Cancer Center K12 Calabresi Immuno-Oncology Training Program"],"award-info":[{"award-number":["Yale Cancer Center K12 Calabresi Immuno-Oncology Training Program"]}],"id":[{"id":"10.13039\/100010900","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Merkel cell carcinoma practice guidelines recommend sentinel lymph node biopsy after wide local excision for the initial management of clinically node\u2010negative disease without distant metastases (cN0M0). Despite guideline publication, treatment selection remains variable. We hypothesized that receipt of guideline\u2010recommended care would be more common in patients evaluated at academic centers and institutions with high melanoma case volumes and that such therapy would be associated with improved overall survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Retrospective cohort analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>The National Cancer Database from 2004 to 2015.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 3500 patients were included. We utilized Kaplan\u2010Meier analysis and logistic and Cox proportional hazard regressions. Survival analysis was performed on inverse probability\u2013weighted cohorts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There has been a trend toward evaluation at academic programs at a rate of 1.58% of patients per year (95% CI, 1.06%\u20102.11%) since 2004. However, the percentage of patients receiving guideline\u2010compliant primary tumor excision and lymph node evaluation has plateaued at approximately 50% since 2012. Guideline\u2010compliant surgical management was more commonly provided to patients evaluated at academic programs than nonacademic programs but only when those institutions had a high melanoma case volume (odds ratio, 2.01; 95% CI, 1.62\u20102.48). Receipt of guideline\u2010compliant primary tumor excision and lymph node evaluation was associated with improved overall survival (hazard ratio, 0.70; 95% CI, 0.64\u20100.76).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Facility factors affect rates of receipt of guideline\u2010compliant initial surgical management for patients with node\u2010negative Merkel cell carcinoma. Given the survival benefit of such treatment, patients may benefit from care at hospitals with high melanoma case volumes.<\/jats:p><\/jats:sec>","DOI":"10.1177\/0194599820967001","type":"journal-article","created":{"date-parts":[[2020,10,20]],"date-time":"2020-10-20T11:03:59Z","timestamp":1603191839000},"page":"1214-1221","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Primary Treatment Selection for Clinically Node\u2010Negative Merkel Cell Carcinoma of the Head and Neck"],"prefix":"10.1002","volume":"164","author":[{"given":"Daniel","family":"Jacobs","sequence":"first","affiliation":[{"name":"Yale University School of Medicine New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelly","family":"Olino","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology Department of Surgery Yale University School of Medicine New Haven Connecticut USA"},{"name":"Yale Cancer Center Yale University School of Medicine New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henry S.","family":"Park","sequence":"additional","affiliation":[{"name":"Yale Cancer Center Yale University School of Medicine New Haven Connecticut USA"},{"name":"Department of Therapeutic Radiology Yale University School of Medicine New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Clune","sequence":"additional","affiliation":[{"name":"Yale Cancer Center Yale University School of Medicine New Haven Connecticut USA"},{"name":"Division of Plastic and Reconstructive Surgery Department of Surgery Yale University School of Medicine New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shayan","family":"Cheraghlou","sequence":"additional","affiliation":[{"name":"Yale University School of Medicine New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Girardi","sequence":"additional","affiliation":[{"name":"Department of Dermatology Yale University School of Medicine New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara","family":"Burtness","sequence":"additional","affiliation":[{"name":"Yale Cancer Center Yale University School of Medicine New Haven Connecticut USA"},{"name":"Division of Medical Oncology Department of Internal Medicine Yale University School of Medicine New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harriet","family":"Kluger","sequence":"additional","affiliation":[{"name":"Yale Cancer Center Yale University School of Medicine New Haven Connecticut USA"},{"name":"Division of Medical Oncology Department of Internal Medicine Yale University School of Medicine New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin L.","family":"Judson","sequence":"additional","affiliation":[{"name":"Yale Cancer Center Yale University School of Medicine New Haven Connecticut USA"},{"name":"Division of Otolaryngology Department of Surgery Yale University School of Medicine New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,10,20]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/000313481508100819"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.14798"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.20167"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.31860"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2017.10.028"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.13782"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2019.01.042"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2014.124"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.13698"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/dju382"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2017.12.001"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.1152586"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djq120"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13555-019-0288-z"},{"key":"e_1_2_9_16_1","unstructured":"American Cancer Society.Survival rates for Merkel cell carcinoma. 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