Treatment Option Overview by Stage for Merkel Cell Carcinoma

Treatment Option Overview by Stage for Merkel Cell Carcinoma

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How Merkel cell carcinoma is treated

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There are treatments for all patients with Merkel cell carcinoma. Three kinds of treatment are used:

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surgery (taking out the cancer)

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radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells)

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chemotherapy (using drugs to kill cancer cells)

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There are several different types of surgery that may be used to remove the tumor. These include:

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Wide surgical excision takes out the cancer and some of the skin around the tumor.

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Cryosurgery freezes the tumor and then removes it.

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Micrographic surgery is a tissue-sparing technique that removes only the tumor.

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Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors.

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Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy).

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Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in a vein or muscle. Chemotherapy is called a systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body.

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If a doctor removes all the cancer that can be seen at the time of the operation, a patient may be given chemotherapy after surgery to kill any cancer cells that are left. Chemotherapy given after an operation to a person who has no cancer cells that can be found is called adjuvant chemotherapy.

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STAGE I MERKEL CELL CARCINOMA

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Treatment may be one of the following:

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1. Surgery alone.

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2. Surgery followed by radiation therapy to the tumor site and regional lymph nodes.

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STAGE II MERKEL CELL CARCINOMA

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Treatment may be one of the following:

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1. Surgery alone.

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2. Surgery followed by radiation therapy to the tumor site and regional lymph nodes.

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3. Surgery with or without radiation therapy followed by adjuvant chemotherapy.

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STAGE III MERKEL CELL CARCINOMA

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Treatment will probably be chemotherapy.

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RECURRENT MERKEL CELL CARCINOMA

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Treatment may be one of the following:

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1. Surgery alone.

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2. Surgery followed by radiation therapy to the tumor site and regional lymph nodes.

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3. Surgery with or without radiation therapy followed by adjuvant chemotherapy.

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Cancer Web UK

Stages of Merkel cell carcinoma

Stages of Merkel cell carcinoma
Stage Explanation

After Merkel cell carcinoma has been diagnosed (found), more tests will be done to find out if cancer cells have spread from the place the cancer started to other parts of the body. The process used to find out whether the cancer has spread to other parts of the body is called staging. It is important to know the stage of the disease to plan the best treatment. The following stages are used for Merkel cell carcinoma:

Stage I

The primary tumor has not spread to lymph nodes or other parts of the body. Lymph nodes are small, bean-shaped structures that are found throughout the body. They produce and store infection-fighting cells.

Stage II

The cancer has spread to nearby lymph nodes, but has not spread to other parts of the body.

Stage III

The cancer has spread beyond nearby lymph nodes and to other parts of the body.

Recurrent stage

Recurrent disease means that the cancer has recurred (come back) after it has been treated. It may come back in the same part of the body or in another part of the body.

Cancer Web UK

Merkel cell carcinoma: outcome and role of radiotherapy

Merkel cell carcinoma: outcome and role of radiotherapy

Cancer Radiother. 2008 Sep

Salvador Alonso R, Lahbabi I, Ben Hassel M, Boisselier P, Chaari N, Lesimple T, Chevrier S, de Crevoisier R.

Département de radiothérapie, centre Eugène-Marquis, avenue Bataille-Flandres-Dunkerque, 35042 Rennes, France.

Merkel cell carcinoma (MCC) are rare neuroendocrine malignant tumor of the skin, occurring in elderly patients. It affects primarily the sun-exposed areas of the skin, with approximately 50% of all tumors occurring in the face and neck and 40% in the extremities. Immunohistochemical markers (CK20+, CK7- and TTF1-) are used to distinguish between MCC and other tumors. MCC have a tendency to rapid local progression, frequent spread to regional lymph nodes and distant metastases. Due to the rarity of the disease, the optimal treatment has not been fully defined. Localized stages (stages I and II) are treated by surgical excision of the primary tumor (with 2 to 3 cm margin) and lymphadenectomy in case of node-positive disease, followed by external beam radiotherapy (EBRT) to a total dose of 50 to 60Gy in the tumor bed. Adjuvant EBRT has been shown to decrease markedly locoregional recurrences and to increase survival in recent studies. Treatment of lymph nodes area is more controversial. Chemotherapy is recommended only for metastatic disease.

Eslevier

Merkel cell carcinoma: histologic features and prognosis.

Merkel cell carcinoma: histologic features and prognosis.
Cancer. 2008 Nov

Andea AA, Coit DG, Amin B, Busam KJ.
Department of Pathology, Memorial Sloan- Kettering Cancer Center, New York, New York, USA. aandea@uab.edu

BACKGROUND: Currently, little is known regarding the potential prognostic value of histologic features in primary cutaneous neuroendocrine (Merkel cell) carcinomas (MCC).

METHODS: In a retrospective review of the tumor histology and clinical outcome data (median follow-up, 51 months; range, 3-224 months) of 156 patients with a diagnosis of MCC, the following histologic features were evaluated: tumor thickness, tumor size (greatest dimension of the tumor), microanatomic compartment involved by tumor (dermis and/or subcutis and/or deeper), tumor growth pattern (nodular circumscribed vs infiltrative), lymphovascular invasion (LVI), tumor-infiltrating lymphocytes, tumor necrosis, ulceration, and solar elastosis.

RESULTS: The overall 5-year survival rate was 67.5%. On univariate analysis, parameters that were associated significantly with survival were tumor thickness (P= .001), tumor size (P= .0002), deepest anatomic compartment involved by tumor (P= .0003), tumor growth pattern (P= .003), LVI (P< .00001), tumor-infiltrating lymphocytes (P= .05), and solar elastosis (P= .04). On multivariate analysis, the presence of a nodular growth pattern, low tumor depth, and absence of LVI were associated with longer survival.

CONCLUSIONS: In addition to the known prognostic value of tumor stage, 3 histologic features were identified to have prognostic significance: tumor thickness (depth of tumor invasion), the presence of LVI, and tumor growth pattern.

Wiley InterScience

Merkel cell carcinoma within follicular cysts: report of two cases.

Merkel cell carcinoma within follicular cysts: report of two cases.
Requena L, Jaqueti G, Rütten A, Mentzel T, Kutzner H.

Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain.

Merkel cell carcinoma is a rare cutaneous neoplasm of unknown histogenesis. Several reports have described the association of Merkel cell carcinoma of the skin with other cutaneous neoplasms within the same lesion, and there are also reports describing three examples of Merkel cell carcinoma within follicular cysts. We describe two examples of Merkel cell carcinoma developed within epithelial cysts. Neoplastic cells of Merkel cell tumor expressed immunoreactivity for chromogranin, synaptophysin, neuron-specific enolase, CAM 5.2 and cytokeratin 20, the last two markers showing the characteristic paranuclear dot-like pattern. In contrast, the epithelial wall lining the cyst and surrounding Merkel cell tumor only expressed immunoreactivity for cytokeratin MNF116. The description of five cases of Merkel cell carcinoma within follicular cysts, including the two cases of this report, support some relationship between Merkel cell tumor and the hair follicle.

J Cutan Pathol. 2008 Dec

PMID: 18988316 [PubMed - in process]

Merkel Cell Carcinoma

Merkel Cell Carcinoma

MD Anderson Cancer Center

Merkel Cell Carcinoma

Merkel Cell Carcinoma (MCC) is a rare skin malignancy which was first described in 1972 by Cyril Toker. However, the name Merkel cell comes from the anatomist who discovered the normal Merkel cell in pig snouts - Friedreich Sigmund Merkel in 1875. Because of the tumor cell characteristics seen under the microscope, the name neuroendocrine carcinoma of the skin is used synonymously with Merkel cell carcinoma.

The true incidence of this cancer is not known, but 400 - 600 cases have been described in the literature. Merkel cell carcinoma is almost exclusively seen in Caucasian people, and most are more than 65 years old. Some of the literature reports that MCC affects men and women equally, but other studies have shown a male predominance. The etiology of this tumor is not clearly defined, but there has been association of MCC to sun exposure. Many of the patients have a history of other basal or squamous cell cancers of the skin, and approximately 10% of the patients will develop a second primary cancer.

Merkel cell carcinoma most commonly occurs in the skin of the head and neck (50%), followed by the extremities and the trunk. The head and neck, cheek, forehead, temple, nose, and upper neck are the most common sites. This tumor is innocuous in appearance - described as a painless, solitary, raised, pink nodule. Most tumors are less than 2 cm when initially discovered. Biopsy is the only way to diagnose MCC. However, the diagnosis is difficult for most pathologists, and requires both the use of the electron microscope and special staining of the cells to differentiate it from other small cell carcinomas.

Merkel cell carcinoma is a very aggressive cancer. Lymph node metastasis occurs early and often. Some studies report palpable lymph nodes at presentation in 45% of patients. However, distant metastasis is rare at presentation. Local and regional recurrence occurs frequently, and is felt to be related to the adequacy of the initial therapy. Distant metastasis occurs in approximately 25% of patients, regardless of therapy.

The current thoughts on treating Merkel cell cancer include both the primary lesion and the regional lymphatics. It is felt that the primary cancer should be surgically removed with negative margins. Studies have shown that surgical treatment alone has a higher rate of local and regional recurrence that those who receive surgical excision and radiation therapy. Thus, after the tumor is removed, 6 weeks of radiation to the surgical site and to the regional lymphatics is recommended. However, despite this aggressive therapy, approximately 40% still develop locoregional recurrence.

It is felt that regardless of therapy, 25 - 35% of patients may ultimately recur. It is felt that the development of locoregional recurrence is a predictor of multiple recurrence and distant metastasis. Thus, it is implied that early locoregional treatment will improve tumor control. However, it is not proven whether locoregional control will affect the rate of distant metastasis and ultimately affect survival.

Merkel cell carcinoma. On one case

Merkel cell carcinoma. On one case

An Sist Sanit Navar. 2008 May-Aug

Cires Bezanilla M, González C, Jiménez F, Rubio T, Amat I.
Servicio de Cirugía General, Hospital García Orcoyen, Estella, 31200, Spain. mcires@gmail.com.

We present the case of an 86 year old woman who was sent for consultation at General Surgery due to asymptomatic tumouration on the back face of the left thigh whose size had increased during the 2 previous months. Physical exploration revealed tumouration that was painless, excrescent, indurated, mobile and well delimited, with a diameter of 5 cm, a reddish colour and a rough surface. Tumoural extirpation was carried out with broad margins, with a hystopathological result of primary cutaneous neuro-endocrynal carcinoma or Merkel cell carcinoma. Computerised tomography was carried out, observing tumoural adenopathies in the para-aortic spaces, iliac chains and left femorals, as well as edema in the lower left extremity.

The patient was sent to the Oncology service for treatment, without presenting a satisfactory evolution and with a progressive deterioration of her general state, dying within the first year after diagnosis.

Anales