What Is Merkel In The Skin
Merkel cells are found in the top layer of the skin. These cells are very close to the nerve endings that receive the sensation of touch. Merkel cell carcinoma, also called neuroendocrine carcinoma of the skin or trabecular cancer, is a very rare type of skin cancer that forms when Merkel cells grow out of control.
What Causes Merkel Cell Cancer
Experts arent exactly sure what causes Merkel cell cancer. But it occurs when Merkel cells in the body change and grow out of control. These abnormal cells may grow to form a lump or mass called a tumor. If the tumor is cancerous, it can grow into nearby areas. It can even spread to other parts of the body .
Radiation Therapy And Chemotherapy
Localized radiation therapy is commonly used to destroy any remaining cancer cells following surgery to remove Merkel cell tumors. Radiation is also occasionally used to treat the area surrounding lymph nodes that have been surgically removed. Radiation therapy delivers penetrating beams of energy waves or streams of particles to the cancer cells and a small margin around the tumor. Radiation therapy can also be used to treat patients who are not candidates for surgery because of ill health or the location of their tumor, or to treat tumors that have returned after an initial round of treatment.
Chemotherapy is another treatment option following surgery. The same platinum-based chemotherapy that is used for small cell lung cancer can be used against Merkel cell carcinoma that has spread to the lymph nodes. Patients whose tumors have spread to distant areas of the body or returned following initial treatment may also be treated with chemotherapy.
Neoadjuvant chemotherapy may be recommended for some patients with large Merkel cell tumors or lymph node involvement. Before this step is taken, however, consideration is needed to ensure that a patient treated with chemotherapy will still be healthy enough to subsequently undergo the surgery or radiation.
Although the rarity of Merkel cell carcinoma has made it difficult to study, researchers continue to evaluate the best ways to use radiation therapy and chemotherapy in caring for patients with the disease.
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What Is The Outlook For Merkel Cell Carcinoma
Merkel call carcinoma is uncommon, so its difficult to estimate an accurate survival rate. The survival rate tells you what percentage of people with the same type and stage of cancer are still alive after a defined period of time after diagnosis.
According to the American Cancer Society, the overall five-year survival rate for MCC is about 60 percent. This means that about 60 percent of people diagnosed with MCC will still be alive after five years.
Your outlook depends on how early the cancer is diagnosed. The following five-year relative survival rates are based on stages 1 through 4 of diagnosis:
- stage 1A: 80 percent
Does Merkel Cell Carcinoma Hurt
While MCC is often painless, it can feel sore and tender. Some people say the growth itches.
Many people who develop MCC are otherwise healthy. If you have certain risk factors, you have a greater risk of getting this skin cancer.
Youll find out what increases the risk of developing MCC at, Merkel cell carcinoma: Causes.
1 Haley CT, Mui UN, et al. Human Oncoviruses: Mucocutaneous Manifestations, Pathogenesis, Therapeutics, and Prevention . J Am Acad Dermatol. doi: 10.1016/j.jaad.2018.09.062. .
2 Coggshall K, Tello TL, et al. Merkel cell carcinoma: An update and review Pathogenesis, diagnosis, and staging. J Am Acad Dermatol 2018;78:433-42.
ImagesImages used with permission of Journal of the American Academy of Dermatology:
Image 1: J Am Acad Dermatol. 2001; 45:309-12.Image 3: J Am Acad Dermatol. 2015; 73:968-75.Image 4: J Am Acad Dermatol. 2012; 66:923-7.Image 5: J Am Acad Dermatol. 2010; 62:463-8. Image 6: J Am Acad Dermatol. 2008; 58:375-81.Image 7: IbidImage 8: J Am Acad Dermatol. 2018; 78:433-42.Image 9: J Am Acad Dermatol.2012; 66:923-7.Image 2: Used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.
ReferencesCoggshall K, Tello TL, et al. Merkel cell carcinoma: An update and review Pathogenesis, diagnosis, and staging. J Am Acad Dermatol. 2018;78:433-42.
Tello, TL. Coggshall K, et al. Merkel cell carcinoma: An update and review Current and future therapy. J Am Acad Dermatol. 2018;78:445-54.
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Coping With Merkel Cell Cancer
Many people feel worried, depressed, and stressed when dealing with cancer. Getting treatment for cancer can be tough on your mind and body. Keep talking with your healthcare team about any problems or concerns you have. Work together to ease the effect of cancer and its symptoms on your daily life.
To help ease your stress:
- Talk with your family or friends.
- Ask your healthcare team or social worker for help.
- Speak with a counselor.
- Talk with a spiritual advisor, such as a minister or rabbi.
- Ask your healthcare team about medicines for depression or anxiety.
- Keep socially active.
- Join a cancer support group.
Cancer treatment is also hard on the body. To help yourself stay healthier, try to:
- Eat a healthy diet, with a focus on high-protein foods.
- Drink plenty of water, fruit juices, and other liquids.
- Keep physically active.
- Rest as much as needed.
- Talk with your healthcare team about ways to manage treatment side effects.
- Take your medicines as directed by your team.
Limitations Of Studies Describing Rt For Mcc
The level of evidence supporting the benefits of RT is important to consider when evaluating its use for MCC. The robustness of the current evidence is hampered by inherent limitations of the studies conducted thus far. Case reports, small retrospective case series or meta-analyses of the same are prone to bias and often lack sufficient numbers to draw definitive conclusions. Moreover, in such reports, the criteria for designating which patients received RT are not often defined. In nonrandomized case series, patient selection can introduce bias that is impossible to control for. For example, during clinical management, physicians will sometimes avoid RT in patients with poor performance status because these patients may not tolerate the treatments. By contrast, some centers may reserve RT for patients with prognostic signs that portend worse outcomes, such as large primary tumors, lymphovascular invasion, positive or close surgical margins or infiltrative growth patterns. Regardless of what motivates the selection, such nonrandom assignments create patient groups that are not comparable in their expected outcomes.
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What Is The Cause Of Merkel Cell Carcinoma
Although the exact cause of Merkel cell carcinoma is unknown, researchers have recently discovered a virus, the Merkel cell polyomavirus , that resides harmlessly on the skin in most people. It is found in the cancer cells of about 8 out of 10 people with MCC. But because MCV is so common and MCC is so rare, it is not clear what role this virus plays in the development of MCC.
What Is A Merkel Cell
Merkel cells are located deep in the top layer of skin. Merkel cells are connected to nerves, signaling touch sensation as touch receptors. MCC was named after Merkel cells due to the similar microscopic features; however, recent research suggests that it is unlikely that MCC originates directly from normal Merkel cells.
Normal Merkel cells in the skin: In this illustration of a cross-section of the skin, normal Merkel cells are shown in red and connect to nerves shown in yellow. The structures drawn include the epidermis , dermis , and deeper adipose layer containing the fatty tissue. Arteries are depicted in red and veins are blue. Figure copyright by Paul Nghiem & Quade Medical Group.
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There Are Three Ways That Cancer Spreads In The Body
Cancer can spread through tissue, the lymph system, and the blood:
- Tissue. The cancer spreads from where it began by growing into nearby areas.
- Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
- Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.
Treatment Of Stage Iii Merkel Cell Carcinoma
For information about the treatments listed below, see the Treatment Option Overview section.
- A clinical trial of chemotherapy.
- A clinical trial of immunotherapy .
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
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Statistics: How Common Is Merkel Cell Carcinoma
Skin cancer is the most common form of cancer in the United States.
Though MCC is much less common than other types of skin cancer roughly 30 times less common than melanoma incidence has been increasing quickly, having quadrupled in the past few decades.
According to the Skin Cancer Foundation, roughly 2,500 new cases of MCC are diagnosed annually in the United States.
Though MCC is very rare, incidence has been rising quickly. A;study published in the March 2018 issue of the;Journal of the American Academy of Dermatology found that between 2000 and 2013, MCC increased by 95 percent. This trend is expected to continue, with annual incidence reaching 3,250 cases per year by 2025.
Some of the uptick in MCC is likely due to the fact that lab tests to diagnose MCC have become more accurate. But it might also be caused by increases in risk factors. More people are living longer, and many people over age 65 did not regularly protect their skin from the sun.
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Treatment Options By Stage
While various considerations help determine the best approach to treatment, the stage of MCC is often the most important factor.Below, learn about the stages and the recommended treatments.
MCC without obvious spread
After having an SLNB to check whether the cancer has spread, most people undergo a wide local excision. This procedure removes the cancerous cells from the skin.
If MCC is on the face or other sensitive areas, a person may instead undergo Mohs micrographic surgery, which helps preserve more healthy skin.
Some people may also, or alternately, undergo radiation therapy, especially targeting the surrounding lymph nodes.
MCC with spread
This can be very difficult to cure. A person may need:
- surgery to remove affected cells
- radiation therapy
- immunotherapy drugs, such as pembrolizumab or avelumab
When MCC comes back, doctors often recommend a combination of:
- surgery to remove more of the affected tissue, possibly with surrounding lymph nodes
- radiation therapy
- immunotherapy drugs, such as Keytruda or Bavencio
Recurring MCC can be very difficult to treat, especially if it comes back in different areas. If this happens, doctors tend to focus on reducing symptoms, not curing the disease.
Some people also try complementary therapies for MCC, including:
- naturopathic medicine
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Preventing Merkel Cell Carcinoma
There are a number of measures you can take to reduce your risk of developing MCC . Its never too late to start.
- Limit UV exposure. You can practice prevention every day by wearing protective hats and clothing, avoiding the midday sun and tanning beds, and using broad-spectrum sunscreen with an SPF of at least 30 even on cloudy days. Reapply sunscreen every two hours when swimming or sweating.
- Keep an eye out.;MCC lesions dont have the dramatic look or color of other skin cancers. Thats why its so important to closely examine your skin from head to toe once a month. If you notice a new or unusual spot or a raised bump that seems to be growing, contact your doctor right away.
- Get screened.;See a dermatologist once every year for a professional skin exam.
If youve been treated for MCC, also be sure to:
- Follow up regularly with your dermatologist once treatment is complete. Stick to the exam schedule your doctor recommends its the best way to quickly detect a recurrence.
- Play close attention to the site and surrounding region.;MCC can return suddenly. Contact your medical team immediately if you see any suspicious changes.
- Consider getting the blood test that can help pick up recurrences early. The Merkel polyomavirus serology test measures antibodies to the Merkel polyomavirus in the blood. It can help pick up recurrences of MCC early, when they can be most effectively treated.
What Is Merkel Cell Carcinoma
MCC is an uncommon form of skin cancer. It begins in the epidermis, the top layer of the skin, near nerve endings. MCC usually progresses quickly. It can be difficult to treat if it metastasizes beyond the skin.
MCC shows up as a discolored bump or lump on an area of skin frequently exposed to the sun. It is also called trabecular carcinoma or neuroendocrine carcinoma of the skin.
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Can I Lower My Risk Of Mcc Progressing Or Coming Back
If you have MCC, you probably want to know if there are things you can do that might lower your risk of the cancer coming back, or of getting a new skin cancer.
At this time, not enough is known about MCC to say for sure if there are things you can do that will be helpful.
We do know that having a weakened immune system can raise the risk of dying from MCC, but this is often something people cant do much about. For example, some people need to take immune-suppressing medicines because theyve had an organ transplant or because they have an autoimmune disease. But for others, there may be things you can do to help keep your immune system strong. For example, its very important for people infected with HIV to take their medicines to help keep the infection under control.
We also know that people who have had MCC have a higher risk for other types of;skin cancerlimit your exposure to UV rays. Because of this, its important to ; and to examine your skin every month for signs of MCC coming back or possible new skin cancers. Skin cancers that are found early are often much easier to treat than those found at a later stage.
Adopting healthy behaviors such as;not smoking,;eating well, being active, and staying at a healthy weight;might help as well, but no one knows for sure. Still, we do know that these types of changes can have positive effects on your health that can extend beyond your risk of MCC or other cancers.
What Is Merkel Cell Carcinoma Symptoms Causes Diagnosis Treatment And Prevention
Klaus D. Peter/Wikimedia Commons
Merkel cell carcinoma is a rare form of skin cancer that arises in Merkel cells, which are found at the base of the outermost layer of skin . Though scientists dont yet know all the functions of these cells, it is clear that one of their roles is to relay the sensation of touch to the brain. They also produce certain hormones.
MCC typically appears as a painless pink or purple bump on sun-exposed areas of skin. It usually spreads first to nearby lymph nodes, and may then spread, or metastasize, to lymph nodes or skin in distant parts of the body, lungs, brain, bones, or other organs.
Merkel cell cancer tends to grow quickly and spread beyond the skin even in the early stages of the disease, making it a difficult cancer to catch and treat soon enough. It is the second most common cause of skin cancerrelated death after melanoma.
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Where Is The Merkel Receptor Located And What Does It Do
Merkels Disks are located superficially in the dermis of skin at the base of the epidermis, and lie adjacent to Meissners corpuscles and sweat glands. These receptors respond to indentation of the skin. They adapt slowly to pressure, and therefore record the sustained presence of pressure on the skin.
Can Merkel Cell Carcinoma Be Cured
The Merkel cell carcinoma is curable cancer if detected and diagnosed early in stages 1 and 2. The patient can live absolutely cancer-free after the treatment but later stages carry a poorer prognosis due to its fast metastatic property. It has got a poor survival rate once detected in late stages that is in stage 3 and 4. This makes it a very dangerous cancer as well as it can spread to various body parts rapidly.
The Merkel cell carcinoma treatment depends upon the stage of cancer at which it is detected. Usually, it is detected in early stages and the mainstay of it is surgical treatment. The tumor could be surgically excised completely with excising a margin of about a few centimeters of the healthy tissue along with it.
The lymph nodes involved are to be removed completely along with cancer surgically; if the tumor is a spreading one then the nearby lymph nodes which are draining that area are excised prophylactically to prevent its spreading.
The adjuvant radiotherapy is given in many cases as it is metastatic cancer and there is always risk involved in spreading to other body parts with it. Radiotherapy makes surgical treatment more successful.
If the Merkel cell carcinoma cancer is in late stages and cannot be resected then immune-suppressing and polychemotherapy with anti-cancer drugs can be given with good success of remission in many patients.
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