Aims To review the treatment outcomes of non-Merkel cell polyomavirus (MCPyV) associated stage I-III Merkel cell carcinoma in a high UV-exposure region. Methodology A retrospective cohort analysis evaluated time-to-event outcome for a North Queensland-based Merkel cell carcinoma (MCC) cohort with immunohistochemistry confirmed negative for CM2B4 antibody, a highly specific antibody that binds to the Merkel cell polyomavirus antigen. The survival endpoints included overall survival (OS), recurrence-free survival (RFS), and distant metastasis-free survival (DMFS). The analyses were performed using the Kaplan-Meier method. Results Forty-three patients were identified, of whom 26 (60%) had head and neck (HN) primaries and 40% had non-HN primaries. All patients underwent PET staging, with 22 classified as stage I, 4 as stage II and 17 as stage III. For locoregional treatment, 13 (30%) received curative radiotherapy alone, 23 (53%) received surgery and post-operative radiotherapy, and 7 (16%) received surgery alone. Twenty patients who developed recurrence received immunotherapy. The median overall survival (OS) was 69.5 months versus 40.8 months (Stage I-II versus Stage III, p=0.37). The median recurrence free survival (RFS) was 33.3 months versus 14.5 months (Stage I-II versus Stage III, p=0.01). The median distant metastasis-free survival (DMFS) was 36.4 months versus 9.6 months (Stage I-II versus Stage III, p=0.001). The cumulative locoregional control rates were similar between stage I-II and stage III, however stage III patients had much higher cumulative distant metastatic rate. Conclusion In our retrospective study, the current standard of locoregional treatments can provide excellent locoregional control rate among stage I to III non-MCPyV associated MCC. However, stage III patients had high cumulative distant metastatic rate. With immunotherapy in the recurrent and metastatic setting, there was no overall survival difference between stage I to III disease.