Immunotherapy Refusal in Merkel Cell Carcinoma is Rare but Correlates with Refusal of Other Treatments: A National Cancer Database Study

Merkel cell carcinoma (MCC) is a rare, aggressive skin cancer for which immune checkpoint inhibitors are standard systemic therapy. Using the National Cancer Database (2011–2020), we identified 2,173 patients recommended immunotherapy; 93 (4.3%) refused. Refusal was more common among older patients (mean 79.7 vs 73.0 years), women, and those with greater comorbidity. In multivariable analysis, radiation refusal strongly predicted immunotherapy refusal (OR 15.06; 95% CI 7.42–30.60). Findings suggest that immunotherapy refusal often accompanies broader treatment hesitancy rather than isolated rejection, underscoring the need to address multimodal decision barriers in MCC care.