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BACKGROUND Sentinel lymph node biopsy (SLN is widely used for Merkel cell carcinoma (MCC), however in SLNB positive MCC the role of completion lymph node dissection (CLND) with or without adjuvant radiation therapy is unclear. OBJECTIVE Our goal was to determine the impact of CLND and adjuvant radiation therapy on survival in SLNB positive MCC. MATERIALS AND METHODS We examined 447 patients with MCC with a positive SLNB in the National Cancer Data Base from 2012 to 2015. We compared patients who underwent CLND versus observation with or