When most people think of skin cancer, the most common forms probably come to mind, like melanoma, basal cell carcinoma, and squamous cell carcinoma.
You probably have never heard of Merkel cell carcinoma (MCC), also known as neuroendocrine carcinoma, because it’s a rare form of skin cancer. But you need to know about it in order to protect your skin and possibly save your life.
Only about 1,500 diagnoses of MCC are made in the United States annually, even though in the past 2 decades occurrences of it have quadrupled.1 Despite its rarity, MCC is an aggressive cancer that can quickly spread throughout the body. It begins in the skin, moves to the lymph nodes, and then can possibly advance to the lungs, bones, or other areas. Because it spreads quickly, this skin cancer is terminal in one third of the people who contract it.2
Merkel cells, also known as neuroendocrine cells, are located in the top layer of the skin called the epidermis. Scientists still have not discovered precisely what Merkel cells do. But because of their close proximity to nerve endings in the skin, it is believed that they register touch sensation. MCC occurs when these Merkel cells multiply uncontrollably.
Risk Factors for MCC
Doctors and scientists still do not know for certain what causes MCC, but they have identified a few risk factors that are associated with the disease.3
- A fair complexion.
- Extended periods of time in the sun or tanning beds.
- A weak immune system, for instance, from HIV or an organ transplant.
- Ages groups above 50.
- White males.
If you have any of these risk factors, talk with your doctor about your chances of getting MCC.
How do you identify MCC?
MCC usually forms on sun-exposed skin as a firm, painless, elevated lump. It’s typically red or skin-colored, and rapidly increases in size over several weeks. MCC can grow on any area of your body, but it tends to grow on areas of skin that are frequently exposed to the sun’s UV radiation, namely, the head, neck, torso, arms and legs.
Early diagnosis significantly increases the chances of surviving MCC. That is why you need to examine your skin at least monthly for MCC tumors and other skin abnormalities, especially if you have any of the aforementioned risk factors.
If you notice a knot on your skin that fits the above description, notify a doctor immediately.
Your doctor will then likely do a biopsy, removing tissue from the lump to be reviewed by a pathologist who will determine if the tumor is malignant. If the pathology tests comeback positive, then the patient will undergo further testing to see if the cancer has spread to other areas of the body.
Treatment
Once the level of cancer has been determined, it’s important that you discuss the best treatment plan with a team of surgical oncologists, radiation oncologists, and dermatologists that have experience with MCC in order to maximize chances of full recovery. Treatment will most likely begin with immediate “wide local excision surgery,” where the tumor and the surrounding tissue are removed. If the cancer has spread to the lymph nodes, the patient will undergo a lymphadenectomy, a surgery in which a portion or a majority of the surrounding lymph nodes are removed.
Depending on the seriousness of the cancer, some patients may be advised to undergo post-surgery therapy to destroy any remaining cancer. Many doctors are now recommending radiation therapy, in addition to surgery, as one of the best forms of treatment because studies have shown that radiation therapy is effective in reducing the chances of MCC returning.4
The Road to Recovery
Chances of recovery in MCC patients depend on the following factors.
- How deep the MCC tumor is rooted in the skin.
- The size of the tumor and the extent of cancer progression throughout the body.
- The location of the tumor.
- Whether this is the first occurrence of MCC or a reoccurrence.
- The age and physical condition of the patient.
A study in the Journal of Clinical Oncology observed that MCC recurred in about half of the tested patients.5 MCC tends to return within the first 3 years of treatment. So for 3 years patients should receive follow-up tests of the skin and lymph nodes every 3 to 6 months. Follow-up tests can become less frequent after 3 years.
There is still a lot of medical research that needs to be done on MCC, but in the meantime, you can take advantage of the information that we do have. The most important thing to remember is this: in order to limit your risk of MCC avoid overexposure to the sun, check your body regularly for lumps, and talk to your doctor about your susceptibility for MCC.
References;
1 Nghiem, P., Siegrid, Y., & Wang, L. (2011). Merkel Cell Carcinoma: Diagnosis, Management and Controversies. American Academy of Dermatology Annual Meeting (pp. 1-12). New Orleans: American Academy of Dermatology.’
2 FAQs About MCC. (2011, June 15). Retrieved from Merkel Cell Carcinoma: www.merkelcell.org/faqs/index.php
3 Merkel Cell Carcinoma Treatment (PDQ). (n.d.). Retrieved from National Cancer Institute: www.cancer.gov/cancertopics/pdq/treatment/merkelcell/Patient/page1
4 Petrou, I. (2006). Merkel cell carcinoma on the rise. Dermatology Times, 106.
5 Allen, P. J., Bowne, W. B., Jaques, D. P., Brennan, M. F., Busam, K., & Coit, D. G. (2005). Merkel Cell Carcinoma: Prognosis and Treatment of Patients From A Single Institution. Journal of Clinical Oncology, 2300-2309
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