Merkel Positron Emission Tomography (PET) Protocol

Inclusion Criteria for Trial Registration: Patients may be registered on the trial only if they meet all of the following criteria: * Age 18 years or older * Written informed consent to participate in the study * Able to undergo 18-FDG PET scan (no uncontrolled diabetes mellitus or severe claustrophobia). * Available for follow-up. * Using adequate contraception if capable of child bearing * Any Merkel Cell carcinoma confined to the primary and/or nodal sites * ECOG 0-2. * Full Blood Count (FBC) should be satisfactory ( Haemoglobin \> or equal to 10g/dl, neutrophils \> or equal to 2.0 x 109 /l and platelets \> or equal to 100 x 109 /l) and renal function (GFR \> or equal to 50 ml/min) and hepatic function ( ALT \< 5 X upper limit normal, bilirubin \< 1.5 X upper limit normal) * Patients must be able to tolerate protocol treatment Exclusion Criteria for Registration: * Previous chemotherapy in the past 5 years or prior radiotherapy to the area of concern * Unable to comply with treatment protocol eg dementia * Other malignancy in the past 5 years other than non-melanoma skin cancer. * Women who are pregnant or lactating. * Clinical evidence of metastatic disease. * Immunosuppression from long term steroid use or immunosuppressive drugs. * Any serious illness or medical condition that precludes the safe administration of the chemotherapy including: 1. Active infection 2. Uncontrolled or unstable cardiac disease including unstable angina, myocardial infarction within the last 3 months, and recurrent ventricular arrhythmias Inclusion Criteria for Treatment Registration: Patients may proceed to protocol treatment if they meet the following criteria: * High risk disease with no evidence of distant spread: Biopsy proven MCC with a primary that is \> 2cm (T2N0M0= Stage II) and/or regional nodes (any T, N1M0= Stage III); OR Recurrent MCC not previously treated with radiation treatment; Dermal or in-transit metastasis with or without nodes; Occult primary with involved nodes * Patients who have no metastases on CT or PET scan OR If CT is suggestive of metastases, they must be PET negative