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What Is Metastatic Merkel Cell Carcinoma

There Are Different Types Of Treatment For Patients With Merkel Cell Carcinoma

Avelumab for Treatment of Metastatic Merkel Cell Carcinoma

Different types of treatments are available for patients with Merkel cell carcinoma. Some treatments are standard , and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

How Merkel Cell Carcinoma Is Treated

Merkel cell carcinoma is a rare and aggressive form of skin cancer. It is a fast-growing cancer that requires early diagnosis and treatment. Treatment usually starts with surgery to remove the primary tumor, the first tumor in the body. Depending on the stage and grade of your cancer, your medical team may also recommend treatment with chemotherapy, radiation therapy, or immunotherapy.;

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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What Leads To Merkel Cell Carcinoma & Can It Be Cured

Merkel cell is receptors formed of neuroendocrine cells which are connected by nerve endings and these take the sensation of touch to the brain. These, in the uppermost layer of skin known as epidermis. The uninhibited proliferation of these cells is known as Merkel cell carcinoma. It is a rare tumor of the skin especially occurring in head and neck areas.

Sentinel Lymph Node Biopsy

FDA Approves Pembrolizumab to Treat Merkel Cell Carcinoma ...

This low-risk procedure involves injecting a radioactive material at the tumor site, where lymph fluid carries it to the sentinel node the first lymph node to which cancer cells will spread. For example, tumors of the leg usually spread first to the groin. The sentinel node is then removed and examined to determine whether cancer cells are present. Surgery to remove the affected lymph nodes may be necessary if the biopsy indicates that the cancer has spread to the sentinel lymph node.

Researchers at Memorial Sloan Kettering were the first to publish the use of sentinel lymph node mapping for Merkel cell carcinoma.;

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What Is Merkel Cell Carcinoma

Cancer starts when cells begin to grow out of control. Cells in nearly any part of the body can become cancer, and can then spread to other parts of the body. To learn more see What Is Cancer?

Merkel cell carcinoma is a rare type of skin cancer. It starts when cells in the skin called Merkel cells start to grow out of control. MCC tends to grow quickly and can be hard to treat if it spreads beyond the skin.

How Dangerous Is Mcc

While MCC is about three to five times more likely to be deadly than melanoma, with early detection, MCC can be treated successfully. If you think you might have MCC, see your doctor. Treatment becomes increasingly difficult once the disease has spread, but new options are now available. Thanks to advances in the field of immunotherapy, MCC survival rates are improving.

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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.

Clinical Manifestations Patient Evaluation Staging

Targetting PD-L1 with avelumab in metastatic Merkel cell carcinoma

MCC often appears as a painless, indurated, erythematous to violaceous nodule with a smooth, shiny surface on sun-damaged skin, and, less commonly, as a plaque with satellite metastases. Surface ulcerations are rare.236238,246,248,287 Heath and colleagues summarized clinical features of MCC in an acronym: AEIOU ,254 suggesting that the clinical appearance of MCC is rather nondescript. MCC occurs predominantly in the head and neck , followed by the extremities and trunk .287 Ten percent of these tumors are in the periocular areas .288 MCC also has been reported in extracutaneous sites, such as the vulva, endocervix, penis, esophagus, bladder, and calvaria.259,289292 The salivary glands, nasal cavity, lip, lymph nodes, vulva, vagina, and esophagus are the most common extracutaneous sites.243 The clinical differential diagnosis includes BCC, SCC, amelanotic melanoma, lymphoma, and metastatic disease. Histologic and immunohistochemical studies are the key to confirmation of the diagnosis.

Diana Bell, in, 2021

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What Are The Clinical Features Of Merkel Cell Carcinoma

Merkel cell carcinoma usually presents as a rapidly enlarging, solitary, irregular red nodule. It is often similar in appearance to other more common skin cancers such as basal cell carcinoma;but grows much more quickly.

Merkel cell cancers spread through the lymphatic system and multiple metastases can develop around the main tumour . Merkel cell carcinoma may also spread to lymph nodes in the neck, axillae and groin. This is more likely in thicker tumours. Most recurrences occur within the first two years after diagnosis.

Merkel cell carcinoma

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Life Expectancy Of Metastatic Merkel Cell Carcinoma

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Stages Of Merkel Cell Carcinoma

Appearance of skin lesions in a patient with Merkel cell ...

After receiving a cancer diagnosis, your doctor will run tests to find out if the cancer has spread to other parts of your body. This is referred to as staging. Staging is important for determining what types of treatment are needed.

In general, a higher number stage means the further a cancer has spread. There are five main stages in MCC :

  • stage 0: the cancer is only in the epidermis and hasnt spread to the lymph nodes
  • stage 1: the cancer is less than 2 centimeters across and hasnt grown into the lymph nodes
  • stage 2: the cancer is more than 2 cm across and hasnt spread to the lymph nodes
  • stage 3: the cancer has grown into lymph nodes as well as nearby tissues
  • stage 4: the cancer has spread to nearby tissues, the lymph nodes, and distant sites, such as the lungs, bones, or brain

The main symptom of Merkel cell carcinoma is the appearance of a single lump or nodule on the skin. The lump is typically:

  • red or violet in color
  • firm to the touch
  • fast-growing
  • painless

The nodule can form anywhere on the body, but most often appears on areas regularly exposed to sunlight, such as the:

  • face
  • neck
  • arms

If the cancer spreads to the lymph nodes, the nodes may grow large enough to be seen as lumps under the skin.

Merkel cell carcinoma can look like many other types of skin cancer at first, so a definitive diagnosis usually isnt made until after a biopsy. Other types of skin cancers often present with:

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Reconstruction After Surgery For Skin Cancer

Any form of surgery can leave a scar, some more noticeable than others. When removal of a Merkel cell carcinoma leaves a wound that is too large to close with simple sutures, Memorial Sloan Kettering surgeons can use skin grafts, flaps, and other reconstructive procedures to help heal the skin and restore its appearance.

How Is Merkel Cell Carcinoma Treated

Many providers have never seen or cared for a patient with MCC. It is important to seek out a healthcare team familiar with MCC. Your care team may include a dermatologist, surgeon, medical oncologist, and/or;radiation oncologist.

Surgery

Surgery is often the first line of treatment for MCC. The goal of surgery to remove the entire MCC lesion while preserving as much surrounding healthy tissue as possible. This may be done through excision of the tumor, MOHS surgery or complete circumferential peripheral and deep margin assessment .;

Radiation

After surgical removal, radiation may be used to further treat the MCC. Radiation therapy uses high energy x-rays to kill cancer cells. Radiation therapy after surgery has been shown to decrease the risk of recurrence of MCC. Radiation is typically delivered daily for several weeks.;

Chemotherapy

Even when tumors are removed by surgery, microscopic cancer cells may be left behind and can spread to distant sites in the body.;Chemotherapy;is medication that can go throughout the entire body to kill cancer cells. Chemotherapy is used in MCC patients when cancer has spread regionally or distantly .

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What Are Merkel Cells

Merkel cells;are found in the top layer of the skin. They are very close to the;nerve;endings that receive the sensation of touch.;Merkel cell carcinoma occurs when Merkel cells grow out of control.

The prognosis for Merkel cell carcinoma depends on several factors, including the size of the tumor, if the cancer cells have spread to other areas of the body, where on the body the tumor is, whether it has recurred, and your overall health and age.;

In this article, we will discuss the various treatment options for Merkel cell carcinoma, as well as possible side effects and prognosis.;

How Is The Stage Determined

Merkel Cell Carcinoma 101 (primary cutaneous neuroendocrine carcinoma)

The staging system most often used for Merkel cell cancer is the American Joint Committee on Cancer TNM system, which is based on 3 key pieces of information:

  • The extent of the tumor : How large is the cancer? Has it grown into nearby structures or organs?
  • The spread to nearby lymph nodes : Has the cancer spread to nearby lymph nodes ?
  • The spread to distant sites : Has the cancer spread to distant lymph nodes or distant organs such as the lungs and skin?

The system described below is the most recent AJCC system as of January 2018.

Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced. Once a persons T, N, and M categories have been determined, this information is combined in a process called stage grouping to get an overall stage. For more on this, see Cancer Staging.

The staging system in the table below uses the pathologic stage . This is the staging system most often used for MCC. It’s decided after testing the tissue taken out during an operation.

Cancer staging can be complex, so ask your doctor to explain it to you in a way you understand.

AJCC Stage

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Cancer May Spread From Where It Began To Other Parts Of The Body

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began and travel through the lymph system or blood.

  • Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor in another part of the body.
  • Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if Merkel cell carcinoma spreads to the liver, the cancer cells in the liver are actually cancerous Merkel cells. The disease is metastatic Merkel cell carcinoma, not liver cancer.

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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Classifying Initial Distant Metastases

The American Joint Committee on Cancer 8th edition staging criteria were followed to define distant metastases as any clinically, pathologically, or radiologically confirmed MCC found beyond the skin-draining lymph nodes of the primary lesion site. In patients without a known primary lesion, metastases were considered âdistantâ if they involved visceral sites, or node beds not directly draining skin , or multiple skin-draining nodes beds that were not contiguous . Radiology data were mostly taken from the scan reports. Uncertain cases were reviewed by University of Washington radiologists to confirm metastatic sites. Pathology data were gathered in cases with biopsy-confirmed distant metastases.

Treatment Of Recurrent Merkel Cell Carcinoma

Metastatic Merkel

For information about the treatments listed below, see the Treatment Option Overview section.

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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Can Merkel Cell Carcinoma Be Prevented

You cannot prevent MCC. You can reduce your likelihood of developing this condition â and any skin cancer â by protecting your skin from exposure to ultraviolet light. Protecting your skin from UV light may include:

  • Limiting your exposure to sunlight
  • Applying and reapplying appropriate sunscreen products while outside
  • Wearing protective clothing while outside
  • Avoiding tanning beds or sunlamps

You can also examine your skin regularly for any signs of change. If you notice any skin changes, see your doctor as soon as possible.

Diagnosing Merkel Cell Carcinoma

Merkel cell carcinoma may be detected during a physical exam by your doctor or dermatologist. Your doctor will check for lumps, lesions, or irregularly shaped moles. They may also ask you for a detailed medical history, history of sun exposure, and if anyone in your family has had skin cancer.

If your doctor finds anything abnormal, they may perform a skin biopsy to check for cancer. During a skin biopsy, a tiny amount of the lump is removed and viewed under a microscope.

If the biopsy is positive for Merkel cell carcinoma, your doctor will run additional tests to determine the stage and extent of the cancer. These tests may include:

  • a sentinel lymph node biopsy, to find out if the cancer has spread to your lymph nodes

Depending on the stage of the cancer and your overall health, your treatment options may include one or more of the following:

  • surgery to remove the tumor and any affected lymph nodes
  • radiation treatment, which directs high energy beams at the cancer cells
  • chemotherapy drugs

Your doctors will discuss the benefits of each option, as well as the possible risks and side effects.

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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.

Patients Can Enter Clinical Trials Before During Or After Starting Their Cancer Treatment

Educational Video Series: What is Merkel Cell Carcinoma (MCC)?

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.

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