Managing Merkel Cell Carcinoma

Merkel cell carcinoma (MCC) is a rare, aggressive, and often fatal neuroendocrine skin cancer – the incidence of which has increased in recent decades. Early and recurrent MCC is managed very differently than other skin cancers.

People at higher risk of developing Merkel cell carcinoma are typically those who have had multiple prior skin cancers and those who are immune suppressed, such as organ transplant recipients.

Merkel cell carcinoma is about 30 times less common than melanoma and its clinical features are not extremely specific, although the AEIOU characteristics can be helpful in identifying a suspicious lesion:

  • ASYMPTOMATIC. An MCC is usually not tender, whereas an inflamed cyst (which looks similar) is tender.
  • EXPANDING RAPIDLY. A bump that has grown significantly in the last one or two months.
  • IMMUNE COMPROMISED. People with long-term T-cell dysfunction are at much higher risk of developing MCC; however, they represent less than 10 percent of all MCC cases.
  • OLDER THAN 50 YEARS.
  • ULTRAVIOLET-EXPOSED FAIR SKIN.

When considered together, almost 90 percent of MCC patients have three or more of these five features. These characteristics should raise alarm bells in general and suggest a biopsy is necessary, even though most of the time the lesion will not be an MCC.

In a 2008 study by Heath et. al., on the day the provider did a biopsy of a lesion that turned out to be Merkel call carcinoma, nearly 60 percent of the providers thought it was a benign lesion, and most were only doing the biopsy at the request of the patient. Only a quarter of the doctors thought the lesions would be some kind of skin cancer.

Merkel cell carcinoma is very different to melanoma and other types of skin cancer. Early MCC can be treated with surgery and radiation, while patients who have developed distant metastatic disease can receive immunotherapy. There is controversy over whether adjuvant radiation therapy is beneficial.

Merkel cell carcinoma is much more likely than other skin cancers to recur in adjacent areas, up to four centimetres away. The cells do not grow as a contiguous ball, but jump through local and distant lymphatic channels. The recurrence rate of MCC is around 50 percent.

Read more latest news on Merkel cell carcinoma management.

 

Source:

Stokowski, L.A. (October 27, 2017.) Merkel Cell Carcinoma: Not Just Another Skin Cancer. Medscape.


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