Management Of Merkel Cell Carcinoma
For patients with operable disease, most agree that surgery is the treatment of choice. As with most tumors, treatment is based on the stage.
Guidelines released in 2015 by a collaborative group of multidisciplinary experts from the European Dermatology Forum , the European Association of Dermato-Oncology , and the European Organization of Research and Treatment of Cancer included the following with regard to the management of Merkel cell carcinoma :
- The primary tumor should be excised with 1-2 cm margins
- In patients with regional lymph node involvement, radical lymphadenectomy is recommended
- Adjuvant radiation therapy may be considered in patients with multiple affected lymph nodes of extracapsular extension
- In unresectable metastatic Merkel cell carcinoma, monochemotherapy or polychemotherapy achieve high remission rates however, responses are usually short-lived
- Treatment within clinical trials is regarded as a standard of care in disseminated Merkel cell carcinoma
After Merkel Cell Carcinoma Has Been Diagnosed Tests Are Done To Find Out If Cancer Cells Have Spread To Other Parts Of The Body
The process used to find out if cancer has spread to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.
The following tests and procedures may be used in the staging process:
Merkel Cell Carcinoma Usually Appears As A Single Painless Lump On Sun
This and other changes in the skin may be caused by Merkel cell carcinoma or by other conditions. Check with your doctor if you see changes in your skin.
Merkel cell carcinoma usually appears on sun-exposed skin as a single lump that is:
- Fast-growing.
- Firm and dome-shaped or raised.
- Red or violet in color.
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Diagnosing And Treating Mcc
One of the issues faced by healthcare providers is that an MCC lesion may look like a cyst or swelling from an inflamed hair follicle. In a clinical study, 56% of Merkel cell carcinomas were initially thought to be benign by physicians. If you notice any new or changing lesions on your skinno matter how minortalk with your healthcare provider. It is important not to delay time to detection.
If your healthcare provider suspects that a lesion on your skin may be MCC, he or she will likely take a careful medical history and perform a physical exam. If your healthcare provider thinks you may have MCC, he or she will do a skin biopsy. That means removing the lesion and sending it to a lab where it will be viewed under a microscope to examine and confirm whether there are any cancerous cells.
Treatment of MCC is based on the stage of the disease and the overall health of the patient. The main treatments are surgery , radiation, and chemotherapy and other systemic therapies .
Research is underway to better understand this disease and to discover treatments. For more information about available clinical trials for Merkel cell carcinoma, go to clinicaltrials.gov or Pfizer: Find a Trial.
Learn more about sun safety
Exposure to the sun is one risk factor for MCC that we can control. We all need some sun exposure, and its important to engage in some physical activity outdoors, but too much sun can be harmful. Find out what you can do to stay healthy in the sun.
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What Are The Signs And Symptoms Of Mcc
MCC usually appears as a single, painless bump on the skin. These bumps are called lesions. The most common site for MCC to occur is the head and neck, followed by the arms and legs. The lesion is typically red/pink, although blue/purple is also common. MCC lesions vary in size but when the cancer is found, they are on average about 17 mm .
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Preventing Merkel Cell Carcinoma
Full body protectionProtect any part of the body that is not covered with UV protective clothing. Use a broad spectrum UVA/UVB sunscreen with a minimum SPF of 30-45.Develop sun-safe habitsAvoid harsh UV rays and seek shade between the suns peak hours from 10 am to 4 pm. Or simply, stay out of the sun.Avoid tanningProlonged UV exposure from tanning beds can lead to as much damage as sun exposure can. Tanning bed use over time can also lead to actinic keratosis. There is no such thing as a healthy tan, or safely pre-tanning before going on a holiday to a sunny destination.Check your skin regularlyKeep an eye out for any changes in spots, freckles, blemishes, or abnormal skin growths. If they hurt, bleed or grow over time, see your doctor.
Overexposure To Uv Radiation
Overexposure to ultraviolet radiation from the sun is the single most important cause of skin cancer. Merkel cell carcinoma is no exception.
UV radiation is a spectrum of invisible rays that are part of the energy produced by the sun. There are two kinds of UV radiation: UVA and UVB. UVB radiation is well known for causing sunburn, and scientists believe these rays cause most skin cancers, including Merkel cell carcinoma. UVA is the dominant tanning ray and, according to the National Cancer Institute, may also cause skin damage that can lead to premature aging and skin cancer.
People who work outdoors, spend a lot of time at the beach, or regularly participate in outdoor sports have an increased risk of developing skin cancer. UVA rays can even travel through glass and clouds. Sun lamps and tanning beds are another source of exposure to harmful UVA rays and should be avoided.
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Survival Rates For Merkel Cell Carcinoma
Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time after they were diagnosed. They cant tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.
Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they cant predict what will happen in any particular persons case. These statistics can be confusing and may lead you to have more questions. Your doctor is familiar with your situation ask how these numbers may apply to you.
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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What Questions Should I Ask My Doctor If I Have Merkel Cell Carcinoma
If your doctor diagnoses MCC, you may have many questions about your condition. These may include:
- How can I know whether the cancer has spread?
- Which treatments will be most beneficial for me?
- Is there a chance my cancer could come back after treatment?
- How can I protect my skin to lessen my chances of developing cancer again?
Make sure you contact your doctor if you notice any changes in your skin that worry you.
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The best way to cite this PDQ summary is:
PDQ® Adult Treatment Editorial Board. PDQ Merkel Cell Carcinoma Treatment. Bethesda, MD: National Cancer Institute. Updated < MM/DD/YYYY> . Available at: . Accessed < MM/DD/YYYY> .
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S Of Merkel Cell Carcinoma
To help you spot MCC, the following pictures show you diverse ways that it can appear on the skin.
A red or pink spot
Looking much like an insect bite, testing revealed that the reddish spot on this patients shin was actually Merkel cell carcinoma.
Reddish, slightly raised spot that looks like a sore
The reddish, scaly, and slightly raised spot on this patients wrist is Merkel cell carcinoma, which could easily have been mistaken for a sore.
Quickly growing spot on your skin that sometimes bleeds
Any spot on your skin that is growing, bleeding, or changing in any way could be a skin cancer.
Quickly growing, firm, dome-shaped growth
This 87-year-old man was concerned about this quickly growing, dome-shaped mass on this lower eyelid, which testing showed was a Merkel cell carcinoma.
A stye or cyst
This aggressive skin cancer can look like a rapidly growing stye or cyst. Unlike a stye or cyst, Merkel cell carcinoma often feels painless.
A growing sore
Sometimes, this aggressive skin cancer looks like a sore, so its important to see a dermatologist if you notice a new spot on your skin that is growing rapidly. Skin cancer can also look like a sore that heals and returns.
Any fast-growing spot or mass
While Merkel cell carcinoma often looks like a dome-shaped growth or slightly raised and scaly patch, it can appear on the skin in diverse ways, as did the Merkel cell carcinoma on this mans head.
Red, pink, or purple spot thats growing
Mcc Stages: Making Sense Of It All
After testing is finished, your medical team will try to pinpoint how far the disease has progressed. This process is known as staging. Staging is a way to understand how much the cancer has grown and how far it has spread. This helps determine how to best treat it, and the risk of it coming back.
The TNM system is frequently used to stage MCC. Its a classification based on three factors:
- T represents the size of the original tumor, its growth rate and other factors.
- N indicates whether the cancer has spread to the local lymph nodes and to what extent.
- M stands for the spread or metastasis to distant lymph nodes and organs.
Once the patients TNM categories have been established, the overall stage number is assigned. As a rule, the lower the stage number, the less the disease has progressed.
MCC Staging
Stage 0
Tumor has not advanced beyond the outermost layer of skin. This stage is also called carcinoma in situ, which means in its original place.
Stage III
Tumor cells have advanced beyond the original tumor and may have traveled as far as the nearby lymph nodes, but not beyond.
Stage I and II
Tumor has not spread to nearby lymph nodes. Stage I includes smaller tumors and stage II includes larger and/or higher-risk tumors.
Stage IV
Tumor cells have spread to distant body areas, lymph nodes or organs.
These stages are each further broken down, from lowest to highest risk, depending on different characteristics of the original tumor and the areas where it has spread.
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How Is Merkel Cell Cancer Treated
Your treatment choices depend on the number of Merkel cell cancer tumors, test results, and the stage of the cancer. The goal of treatment may be to cure you, control the cancer, or to help ease problems caused by cancer. Talk with your healthcare team about your treatment choices, the goals of treatment, and what the risks and side effects may be.
Types of treatment for cancer are either local or systemic. Local treatments remove, destroy, or control cancer cells in one area. Surgery and radiation are local treatments. Systemic treatment is used to destroy or control cancer cells that may have traveled around your body. When taken by pill or injection, chemotherapy and targeted therapy are systemic treatments. You may have just one type of treatment or a combination of treatments.
Sometimes more than 1 type of treatment is used. Treatment may include:
Talk with your healthcare providers about your treatment options. Make a list of questions. Think about the benefits and possible side effects of each option. Some treatments may affect your ability to have children in the future. Talk about your concerns with your healthcare provider before making a decision.
What Causes Merkel Cell Carcinoma
Merkel cell carcinoma originates in cells at the bottom of the epidermis, known as the Merkel cells. The epidermis is the outer layer of the skin. Merkel cells are connected to nerve endings that give us our sense of touch.
Merkel cell carcinoma occurs when something goes wrong within these cells and causes them to grow uncontrollably. Researchers havent yet pinpointed the exact cause. have recently found that a virus known as the Merkel cell polyomavirus might play a role.
Other known risk factors include:
- being older than 50 years old
- excessive sun exposure
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Which Type Of Lung Cancer Spreads The Fastest
Small cell lung cancer usually grows and spreads faster than non-small cell lung cancer. Around 70% of small cell lung cancers have already spread at the time of diagnosis. There are some forms of non-small cell lung cancer that are also fast-growing, such as large cell undifferentiated carcinoma and large cell neuroendocrine carcinoma.
Immune Function & Merkel Cell Carcinoma
Patients with weakened immune systems are at significantly higher risk of developing MCC. Conditions associated with weakened immunity include HIV/AIDS, kidney or heart transplantation, and autoimmune diseases requiring medications that suppress the immune system, chronic lymphocytic leukemiachronic lymphocytic leukemiaA slow-growing type of leukemia associated with immune suppression. Patients with CLL have a markedly increased risk and severity of Merkel cell carcinoma. and certain types of lymphoma. The risk of developing MCC is 8 times greater in HIV patients, 10 times greater in organ transplant patients, and about 40 times greater in CLL.234 Long-term suppression of the immune system appears to be a risk factor for MCC in some patients. While patients with profound immune suppression are at a higher risk of developing MCC, over 90% of all people who develop MCC have no known immune deficiency.3
The immune system is also very important after diagnosis of MCC. Patients whose tumors show a robust immune response with certain immune cells present in their tumor tend to do better.5 MCC patients without a primary tumor also do better, likely because their immune system was able to eliminate the primary tumor and thus are more likely to be able to fight small amounts of MCC elsewhere in the body as well.6 In contrast, patients on medications that reduce immune function are at higher risk of having their MCC recur.
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Patients Can Enter Clinical Trials Before During Or After Starting Their Cancer Treatment
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCIs clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
What Are The First Symptoms Of Merkel Cell Carcinoma & How Do You Test For It
Merkel cell carcinoma is rare skin cancers that can metastasize to distant organs. It usually affects old people. Constant exposure to the sun and weak immune system can cause this cancer. It develops as a single red or purple lump on the skin. It is a rapidly growing cancer. It appears mainly on sun-exposed areas. It can be detected with a skin biopsy, X-ray, MRI scan, CT scan and others. It can be treated with surgery, radiation therapy and chemotherapy.
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Workup In Merkel Cell Carcinoma
Baseline laboratory studies should include a complete blood count , a chemistry profile, and liver function tests.
No optimal imaging algorithm has been defined. However, because of the difficulties in distinguishing metastatic oat cell carcinoma from Merkel cell carcinoma , chest radiography should be performed. Obtain computed tomography scans of the chest, abdomen, and pelvis to rule out metastases.
Light microscopy, electron microscopy, and immunohistochemistry may be needed to confirm the diagnosis of Merkel cell carcinoma .
No universally accepted staging system for Merkel cell carcinoma exists. Some have used the American Joint Committee on Cancer Staging System for skin cancer to stage Merkel cell carcinoma . Others employ a staging system developed by the Memorial Sloan Kettering Cancer Center or the system suggested by Yiengpruksawan et al .