Signs And Symptoms Of Merkel Cell Carcinoma
Merkel cell carcinoma usually starts on areas of skin exposed to the sun, especially the face, neck, arms, and legs, but it can occur anywhere on the body. It often first appears as a single pink, red, or purple shiny bump that usually doesn’t hurt. Sometimes the skin on the top of the tumor breaks open and bleeds.
These tumors grow quickly. They might spread as new lumps in the nearby skin. They might also reach nearby lymph nodes . Over time, the lymph nodes might grow large enough to be seen or felt as lumps under the skin .
Merkel cell carcinoma is rare, and it can look like many other, more common types of skin cancer or other skin problems when it first appears. Because of this, doctors usually don’t suspect MCC at first, and the diagnosis is often made only after the tumor is biopsied.
Its very important to have any new, growing, or changing lumps, bumps, or spots on your skin checked by a doctor as soon as possible so that the cause can be found and treated, if needed. The earlier any type of skin cancer is found, the easier it might be to treat.
What Are The Symptoms Of Merkel Cell Carcinoma
In most cases, MCC causes a small reddish or purplish lump or bump to form on areas of skin often exposed to ultraviolet light, such as the face, neck, arms, and hands. The lumps usually do not cause pain. In some cases, bumps appear inside the nostrils or esophagus. Lumps or bumps may crack open and bleed.
Immunotherapy Treatments For Merkel Cell Carcinoma
If the cancer has spread, your doctor may recommend immunotherapy. Clinical trials suggest immunotherapy drugs may be more effective against Merkel cell carcinoma than chemotherapy.
Two FDA-approved immunotherapy drugs for Merkel cell carcinoma are avelumab and pembrolizumab. Side effects of immunotherapy drugs can include fatigue, inflammation, itchiness, skin reactions, high or low blood pressure, and flu-like symptoms.
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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.
Is Merkel Cell Carcinoma Painful
4.1/5Merkel cell tumors
Also to know is, does Merkel cell carcinoma hurt?
Merkel cell carcinoma usually starts on areas of skin exposed to the sun, especially the face, neck, arms, and legs, but it can occur anywhere on the body. It often first appears as a single pink, red, or purple shiny bump that usually doesn’t hurt.
Beside above, how aggressive is Merkel cell carcinoma? Merkel cell carcinoma is a rare, aggressive form of skin cancer with a high risk for returning and spreading , often within two to three years after initial diagnosis.
Also to know, what does Merkel cell cancer look like?
Merkel cell carcinomas look like red, blue, or flesh-colored lumps that appear on sun-exposed areas of the skin. Merkel cell carcinoma can spread to regional lymph nodes as well as distant sites in the body. Like melanoma, the prognosis for Merkel cell carcinoma that has spread is poor.
How does Merkel cell carcinoma kill you?
Merkel cells are found in the top layer of the skin. It usually spreads first to nearby lymph nodes and then may spread to lymph nodes or skin in distant parts of the body, lungs, brain, bones, or other organs. Merkel cell carcinoma is the second most common cause of skin cancer death after melanoma.
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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.
Treatment Of Recurrent Merkel Cell Carcinoma
For information about the treatments listed below, see the Treatment Option Overview section.
- Radiation therapy and/or surgery as palliative treatment to relieve symptoms and improve quality of life.
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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The Following Stages Are Used For Merkel Cell Carcinoma:
Stage 0
In stage 0, abnormalMerkel cells are found in the top layer of skin. These abnormal cells may become cancer and spread into nearby normal tissue.
Stage I
In stage I, the tumor is 2 centimeters or smaller.
Stage II
Stage II Merkel cell carcinoma is divided into stages IIA and IIB.
- In stage IIA, the tumor is larger than 2 centimeters.
- In stage IIB, the tumor has spread to nearby connective tissue, muscle, cartilage, or bone.
Stage III
Stage III Merkel cell carcinoma is divided into stages IIIA and IIIB.
In stage IIIA, either of the following is found:
- the tumor may be any size and may have spread to nearby connective tissue, muscle, cartilage, or bone. A lymph node cannot be felt during a physical exam but cancer is found in the lymph node by sentinel lymph node biopsy or after the lymph node is removed and checked under a microscope for signs of cancer or
- a swollen lymph node is felt during a physical exam and/or seen on an imaging test. When the lymph node is removed and checked under a microscope for signs of cancer, cancer is found in the lymph node. The place where the cancer began is not known.
In stage IIIB, the tumor may be any size and:
Stage IV
In stage IV, the tumor has spread to skin that is not close to the primary tumor or to other parts of the body, such as the liver, lung, bone, or brain.
How Fast Does Merkel Cell Carcinoma Spread
A physical exam may reveal a new skin lesion, an enlarged lymph node or an enlarged liver that may signal the spread of MCC. A lesion of metastatic MCC may appear as a 1-3 cm, flesh-colored to red-purple bump that feels firm, is deeper compared to the primary lesion, and grows rapidly over a period of 2-4 weeks.
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Four Types Of Standard Treatment Are Used:
Surgery
One or more of the following surgical procedures may be used to treat Merkel cell carcinoma:
- Wide local excision: The cancer is cut from the skin along with some of the tissue around it. A sentinel lymph node biopsy may be done during the wide local excision procedure. If there is cancer in the lymph nodes, a lymph node dissection also may be done.
- Lymph node dissection: A surgical procedure in which the lymph nodes are removed and a sample of tissue is checked under a microscope for signs of cancer. For a regional lymph node dissection, some of the lymph nodes in the tumor area are removed for a radical lymph node dissection, most or all of the lymph nodes in the tumor area are removed. This procedure is also called lymphadenectomy.
After the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer. It is used to treat Merkel cell carcinoma, and may also be used as palliative therapy to relieve symptoms and improve quality of life.
Chemotherapy
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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Surgical Treatments For Merkel Cell Carcinoma
The first step in treating Merkel cell carcinoma is usually surgery to remove the tumor, assuming it has not spread beyond your lymph nodes. Your surgeon will remove the tumor and surrounding tissue and may perform a sentinel lymph node evaluation to assess if the cancer has spread to the lymph nodes. This can allow for accurate staging, which will then guide consideration for preventative treatments or inclusion into clinical trials.
Surgery usually leaves some type of scarring. The most common risk for surgeries is infection. Ask your doctor how to reduce your risk of infection after surgery and about any other possible side effects.
Merkel Cell Carcinoma: Causes Symptoms And Treatment
Merkel cell carcinoma is a rare, aggressive type of skin cancer.
Merkel cell carcinoma gets its name because these skin cancer cells resemble Merkel cells, which are located in the top layer of skin. Merkel cells are most concentrated in the fingertips, lips, and face, but MCC cells are most likely to develop on the head, neck, and other areas that have received the most sun exposure.
Below, learn about the causes of MCC, its symptoms, and how to prevent it. We also describe the diagnosis and treatment options.
Carcinoma is a type of cancer that develops in the skin or tissues covering or lining internal organs. Cancer occurs when cells begin to randomly divide and grow out of control. This cellular growth eventually forms a mass called a cancerous tumor.
MCC is one type of skin cancer, and its cells resemble Merkel cells. These are located close to the skins nerve endings and help provide a sense of light touch. They also relay information from the skin to the brain about details such as pressure and texture.
Merkel cells share traits with nerve and hormone-producing cells. As a result, they are classed as neuroendocrine cells, and MCC, in turn, is sometimes called neuroendocrine carcinoma of the skin. Another name for MCC is trabecular carcinoma.
MCC is very rare. In 2018, around 2,000 people in the United States received the diagnosis. However, its prevalence seems to be growing.
risk factors include:
MCC usually develops on the:
- face
- arms
- legs
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Treatment Of Stage Iv Merkel Cell Carcinoma
For information about the treatments listed below, see the Treatment Option Overview section.
- 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.
We Were One Of The First And Are Still One Of The Few Multidisciplinary Programs In The Country Created Solely To Treat Patients With Merkel Cell Carcinoma Call Us At 734
Merkel cell carcinoma is a rare and potentially aggressive form of skin cancer. Though the cancer can grow and spread rapidly, it is highly treatable and curable if caught in the early stages.
Merkel cell carcinoma is best managed with the collaboration of multiple surgical and medical specialties offered in the programs Cutaneous Oncology Program. Our physicians offer experience and expertise in treating this disease at all stages.
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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
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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My Battle With Merkel Cell Cancer
This is a highly malignant cancer. I discovered it in May,2010. I had surgery and radiation. I also developed posterior mediastinal and small bowel metastases. I had chemotherapy. After a good response, I had chemoradiation of the mediastinum. I am now battling with post irradiation esophageal recurrance.Dave Shuster passed away on April 18, 2012 from complications of Merkel Cell Carcinoma. A copy of this blog in PDF format is available at http://dave.shuster.com/
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 .
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Enhancing Healthcare Team Outcomes
MCC is a very rare skin tumor that may present to the primary care provider, nurse practitioner or internist. These lesions may present as an aymptomatic growth or a painful lesion on the head and neck area. It is important to refer these patients to the dermatologist for definitive work up. Patients with a diagnosis of MCC require an interprofessional approach that includes an oncologist, radiologist, surgeon and require close follow-up with their dermatologist. Todate, the prognosis for most patients is guarded if the lesion is metastatic at the time of diagnosis, survival past 12 months is rare. Fortunately, clinical trials utilizing immunomodulating agents such as anti-PD-1 and PD-L1 antibodies have shown great promise in providing improved progression-free survival.
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How Is Merkel Cell Cancer Diagnosed
The most common way to find Merkel cell cancer is when a lump is found and you see a healthcare provider about it. The healthcare provider will look at and feel the lump. They will ask about your health history, and do a physical exam of your skin.
You may be sent to a dermatologist. This is a doctor with special training to treat skin problems. The doctor may use a special light, magnifying lens, or camera to get a very close look at the lump. You will likely need a biopsy.
A biopsy is the only way to know if a lump or change is cancer. The doctor takes small pieces of tissue from the lump. These samples can be removed with a needle or scalpel, or during surgery. They are checked with a microscope to look for cancer cells.
It can be hard to diagnose MCC. It can look like many other types of cancer. Special lab tests can be used on the biopsy sample to find out whats caused the skin change.
After a diagnosis of MCC, youll likely need more tests. These help your healthcare providers learn more about the cancer. They can help determine the stage of cancer. The stage is how much and how far the cancer has spread in your body. Its one of the most important things to know when deciding how to treat MCC.
Once your cancer is staged, your healthcare provider will talk with you about what the stage means for your treatment. Ask your healthcare provider to explain the stage of your cancer to you in a way you can understand.
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