Merkel cell carcinoma: a retrospective study on 48 cases and review of literature.

Sept 2012

Cirillo F, Vismarra M, Cafaro I, Martinotti M.

Source

Department of General Surgery, General Surgery Unit, Rare Hormonal Tumors Group, Surgery of Rare Hormonal Tumors, Azienda Ospedaliera Istituti Ospitalieri, Viale Concordia 1, 26100 Cremona, Italy.

Abstract

Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine tumor of the skin. Fourty-eight patients with MCC were observed at the Rare Hormonal Tumors Group of Cremona Hospital, 15 of these with unknown primary site. Due to rarity of Merkel cell carcinoma, clinical experience is generally limited. Data from our series confirm the current recommendations. Wide surgical excision must be associated with radiotherapy also in early stages in order to avoid local relapse and the rapid progression of disease. In advanced stages chemotherapy is the standard despite the short duration of responses and poor quality of life. The data of our series, characterized by a high demand for second opinion, offer some insight about the real rarity of the tumor, the difficulty of managing of disease in our country secondary to a wrong cultural approach to the problem, the indiscriminate use of molecules unnecessary and often expensive, the lack of protocols, and the presence of guidelines often ignored. This results in very poor survival associated with a very low quality of life, requiring to find the right direction towards a correct management of disease.

NIH

Treatment Option Overview by Stage for Merkel Cell Carcinoma

Treatment Option Overview by Stage for Merkel Cell Carcinoma

-

How Merkel cell carcinoma is treated

-

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

-

surgery (taking out the cancer)

-

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

-

chemotherapy (using drugs to kill cancer cells)

-

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

-

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

-

Cryosurgery freezes the tumor and then removes it.

-

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

-

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

-

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).

-

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.

-

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.

-

STAGE I MERKEL CELL CARCINOMA

-

Treatment may be one of the following:

-

1. Surgery alone.

-

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

-

STAGE II MERKEL CELL CARCINOMA

-

Treatment may be one of the following:

-

1. Surgery alone.

-

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

-

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

-

STAGE III MERKEL CELL CARCINOMA

-

Treatment will probably be chemotherapy.

-

RECURRENT MERKEL CELL CARCINOMA

-

Treatment may be one of the following:

-

1. Surgery alone.

-

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

-

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

-

Cancer Web UK