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Merkel Cell Carcinoma Symptoms, Treatment and Survival

Merkel Cell Carcinoma, Merkel Cell tumor

Merkel Cell CarcinomaSigns and Symptoms

Merkel Cell Carcinoma Symptoms can be easily recognized by a health professional during medical exam; although its warning signs can be neglected by the patient. The cancer usually appears on skin areas that are frequently exposed to sunlight. It appears as a single mass that is:

 

  • rapidly changing
  • painless
  • firm or raised
  • Have one color: red, pink, blue, or purple

    Progression and Complications

    As the tumor progresses, Merkel cell carcinoma tends to spread, most often, to the liver, lungs, bone, the brain, regional lymph nodes, or distant lymph nodes, thus making the survival more difficult. Presence of any of these metastases decreases considerably the chance of the patient to heal or survive for more than 5 years.  

  

Merkel Cell CarcinomaTreatment 


Merkel Cell Carcinoma treatment depends on the stage or the evolution of the cancer at diagnosis. It is therefore necessary for the health care provider to perform an assessment of the extent of the tumor before considering a therapeutic approach. This assessment, in addition to a complete physical examination, will include an ultrasound of the lymph nodes, CT scan of the thoracic and abdominopelvic organs. Depend on the characteristics of the cancer, brain scans can also be recommended. Some health professionals go further to envisage bone scan or a PET scan


Stages I and II – at these stages, a surgical removal of the lesion, with very small or medium margins of 3 cm, is performed in most cases. Local radiotherapy can be considered to reduce the incidence of local recurrence. Conventionally, radiation therapy in the lymph node is often associated with the surgery in case of metastases in the sentinel node, but there is no evidence of improvement in terms of survival. 


Stage III- in this stage, spreading of the cancer to regional lymph node is usually confirmed; removal of the tumor and the affected lymph node is often the ideal therapeutic approach. This surgery is completed by radiotherapy. If there is a recurrence, chemotherapy is discussed and recommended, according to the general condition of the patient.

Stage IV – at this last stage, the patient can have metastasis in the liver, bone, lung, brain or skin. The treatment is palliative combining radiation therapy and chemotherapy. Surgical resection of a solitary metastasis is possible, but barely effective.

Chemotherapy: adjuvant chemotherapy is given to the patient if the lymph nodes or distant organs are affected. But the therapy causes side effects which can be permanent and serious. Please see the chemotherapy side effects section for more details.  

 

Certain chemotherapeutic agents used in Merkel Cell Carcinoma Treatment include:

  • doxorubicin (Adriamycin)
  • cyclophosphamide (Cytoxan, Procytox)
  • cisplatin (Platinol AQ)
  • 5-fluorouracil (5-FU, Efudex)
  • dacarbazine (DTIC)
  • vindesine (Eldesine)
  • etoposide (Vepesid).

 

 

  Merkel cell carcinoma causes and diagnosis

 

 

References: 

1- Toker C. Trabecular carcinoma of the skin Arch. Dermatol. 1972 ; 105 : 109-110  

2- Heath M., Jaimes N., Lemos B., Mostaghimi A., Wang L.C., Peñas P.F., et al. Clinical characteristics of Merkel cell carcinoma at diagnosis in 195 patients: the AEIOU features J Am Acad Dermatol. 2008 ; 58 : 375-381  

3- Engels E.A., Frisch M., Goedert J.J., Biggar R.J., Miller R.W. Merkel cell carcinoma and HIV infection Lancet. 2002 ; 359 : 497-498 

4- Heath, M., Jaimes, N., Lemos, B., Mostaghimi, A., Wang, L. C., Peñas, P. F., & Nghiem, P. (2008). Clinical characteristics of Merkel cell carcinoma at diagnosis in 195 patients: the AEIOU features. Journal of the American Academy of Dermatology58(3), 375-381.