Merkel Cell Carcinoma

Merkel Cell Carcinoma (MCC) is a rare and aggressive form of skin cancer occurring in the Merkel cells. Merkel cells are present in the outer layer of skin (epidermis) and give rise to the sensation of touch. MCC may present as an asymptomatic, rapidly enlarging nodule in sun-damaged areas of the face, neck, or arms. Being very aggressive in nature, it is highly prone to metastasizing to lymph nodes and other organs.

Merkel Cell Carcinoma is an aggressive, rare skin cancer that must be detected early and treated aggressively. New advances in immunotherapy and current clinical trials provide optimism for better prognosis. Skin examination every few months, sun avoidance, and immune system health are important preventive factors. If you notice any new skin changes, please contact a medical provider as soon as possible for evaluation and diagnosis.

The exact cause of MCC is not always clear, but several factors can increase the risk of developing this cancer:

• Merkel Cell Polyomavirus (MCV): This virus is present in most MCC cases and may contribute to the development of the cancer.
• Sun Exposure: Prolonged exposure to ultraviolet (UV) rays increases the risk.
• Weakened Immune System: People with compromised immune systems, such as those with HIV/AIDS, organ transplant recipients, or individuals undergoing immunosuppressive therapy, are at higher risk.
• Age and Skin Type: MCC is more common in older adults, particularly those with fair skin.
• Previous Skin Cancer: A history of other skin cancers may increase the likelihood of MCC.

MCC usually presents as a painless, firm, shiny nodule that may be skin-colored, red, purple, or bluish. Symptoms may include:

• Rapid growth of the nodule
• A lump that feels tender
• Skin changes, such as ulceration
• Swollen lymph nodes if the cancer has spread

Diagnosis of MCC typically involves:

• Physical Examination: A thorough skin check for suspicious lumps.
• Skin Biopsy: A sample of the skin growth is removed and analyzed under a microscope.
• Imaging Tests: CT scans, MRI, or PET scans may be performed to check for cancer spread.
• Sentinel Lymph Node Biopsy (SLNB): Determines if the cancer has spread to nearby lymph nodes.

Treatment for MCC depends on the stage of the disease, overall health, and other factors. Common treatment approaches include:

• Surgery: The primary treatment to remove the tumor and nearby lymph nodes if necessary.
• Radiation Therapy: Often used after surgery to target any remaining cancer cells.
• Chemotherapy: Used in advanced cases where the cancer has spread.
• Immunotherapy: Immune checkpoint inhibitors such as Avelumab or Pembrolizumab are effective for metastatic MCC.

While MCC cannot always be prevented, these measures can reduce the risk:

• Protect your skin from excessive sun exposure by using sunscreen and wearing protective clothing.
• Avoid tanning beds.
• Conduct regular skin checks for new or unusual growths.
• Manage underlying immune conditions effectively.

Prognosis depends on the stage of the cancer at diagnosis. Early detection improves outcomes, with a five-year survival rate of around 64% for localized MCC. However, metastatic MCC has a lower survival rate.

Living with MCC involves ongoing medical care, follow-ups, and emotional support. Patients can benefit from support groups, mental health counseling, and managing side effects of treatments.

Research in MCC treatment is rapidly evolving, with advancements in immunotherapy leading the way. Clinical trials are exploring combinations of immunotherapy and targeted therapies to improve outcomes.

• Cancer Support Communities: Offer counseling, patient support groups, and information.
• Clinical Trials: Sites like ClinicalTrials.gov provide information on available trials.
• Cancer Organizations: Groups like the American Cancer Society and Skin Cancer Foundation provide resources and guidance.

Clinical trials play a crucial role in advancing MCC treatment. Patients can consider enrolling in trials to access new therapies. Consult an oncologist to explore suitable options.