Given the early dissemination of MCC and the poor prognosis once metastasis has occurred, aggressive treatment for stage I disease must be considered. Radiation therapy may be palliative and may have an increasing role as prophylactic protection in early disease. Chemotherapy has been employed in regional spread of disease (stage II). Will chemotherapy utilized in earlier stages of disease be a possible solution? Could combined chemoimmunotherapy be a useful compliment to the modest success of radiation treatment? These modalities are only as good as their practical use in the typical elderly patient with MCC, and addressing this challenge will be crucial in future research. back to top