Background: Previous work has suggested that facility-level characteristics, such as case volume and academic affiliation, are associated with patient survival for rare malignancies. Merkel cell carcinoma (MCC) is a rare neuroendocrine skin cancer with high mortality and rising incidence. The effect of facility characteristics on MCC outcomes is not yet established.

Objective: We aimed to investigate whether facility academic affiliation or case volume was associated with MCC patient survival.

Methods: We conducted a retrospective cohort analysis of US adult MCC cases diagnosed during 2004-2014 in the National Cancer Database.

Results: Both facility academic affiliation (P < .001) and case volume (P < .001) were significantly associated with patient survival. The 5-year survival of patients treated at academic facilities was 63.0% (standard error [SE] 1.7) and that of a propensity score- matched cohort of patients treated at nonacademic facilities was 53.4% (SE 1.9). The 5-year survival of patients treated at high-case volume facilities was 67.4% (SE 2.1) and that of a propensity score-matched cohort of patients treated at low- and intermediate-case volume facilities was 58.6% (SE 2.0).

Limitations: Disease-specific survival and local recurrence data were not available.

Conclusion: Treatment of MCC at academic and high-volume centers is associated with significantly improved patient survival. Further studies evaluating comorbidities and disease-specific survival are needed to establish whether experienced centers have improved outcomes in MCC treatment.