From the American Academy of Ophthalmology

In what is presumably the largest case series of primary merkel cell carcinoma of the eyelid, researchers found significant rates of recurrence and metastases, as well as a significant mortality rate. A wide local excision with 5-mm margins and histological margin control remains the mainstay of treatment, and adjuvant radiotherapy may play a role in prevention of recurrent disease for selected patients. However, recurrent disease and regional/distant metastases do occur in patients who have disease localized to the eyelid or a lower T category tumor and in those who receive prophylactic radiotherapy. As a result, sentinel lymph node biopsy or a radiological nodal assessment should be considered for all patients as part of the initial staging process. JAMA Ophthalmology, February 2014