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Dermatologic Manifestations of Merkel Cell Carcinoma Follow-up

  • Author: Christopher R Shea, MD; Chief Editor: William D James, MD  more...
 
Updated: Sep 14, 2015
 

Deterrence/Prevention

Photoprotection (eg, sunscreen, behavioral prevention) may help prevent Merkel cell carcinoma (MCC), but this is not proven. Also see Sunscreens and Photoprotection.

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Complications

Complications secondary to metastasis depend on the anatomic sites of involvement.

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Prognosis

Partial or complete spontaneous regression (reminiscent of that sometimes seen in melanoma) is a well documented but rare phenomenon in Merkel cell carcinoma and may be more common in women than in men.[44] Even some metastases may remit spontaneously. Regression is accompanied by dense lymphocytic infiltrates, primarily of the CD8 phenotype, and proceeds via apoptosis (as documented ultrastructurally and by the in situ DNA nick end labeling [TUNEL] technique).

Local cutaneous recurrence occurs after wide excision in 30-40% of patients with clinical stage I Merkel cell carcinoma; local invasion of contiguous organs (eg, intracranial) is also possible. Regional lymph node metastasis occurs in 50-79% of patients, and distant metastasis occurs in more than 30% of patients; major sites include liver, bone, central nervous system, lung, and skin.

Overall, the mortality rate is 30-50% in 2 years; few studies include longer-term follow-up. Women appear to have a better survival rate than men. Histopathologic features associated with a lower survival rate include small cell size, high mitotic rate, subcutaneous invasion, diffuse growth pattern, heavy lymphocytic infiltrates, increased vascular density, lymphovascular invasion, mast cell count, and tumor size greater than 5 mm.[13, 45]  

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Patient Education

For patient education resources, see the Cancer and Tumors Center, as well as Skin Cancer and Skin Biopsy.

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Contributor Information and Disclosures
Author

Christopher R Shea, MD Professor and Chief, Section of Dermatology, Department of Medicine, University of Chicago, The Pritzker School of Medicine

Christopher R Shea, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society of Dermatopathology, Society for Investigative Dermatology, Association of Professors of Dermatology, International Society of Dermatopathology, Arthur Purdy Stout Society, Chicago Dermatological Society, Dermatology Foundation, Illinois Dermatological Society

Disclosure: Nothing to disclose.

Coauthor(s)

Victor G Prieto, MD, PhD Director of Dermatopathology, Professor, Departments of Pathology and Dermatology, University of Texas MD Anderson Cancer Center

Victor G Prieto, MD, PhD is a member of the following medical societies: American Society of Dermatopathology, College of American Pathologists, American Association for the Advancement of Science, International Society of Dermatopathology, European Society of Pathology, American Medical Association, American Society for Clinical Pathology, Society for Investigative Dermatology, United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

John G Albertini, MD Private Practice, The Skin Surgery Center; Clinical Associate Professor (Volunteer), Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine; President-Elect, American College of Mohs Surgery

John G Albertini, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery

Disclosure: Received grant/research funds from Genentech for investigator.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Susan M Swetter, MD Director, Pigmented Lesion and Melanoma Program, Professor, Department of Dermatology, Stanford University Medical Center and Cancer Institute, Veterans Affairs Palo Alto Health Care System

Susan M Swetter, MD is a member of the following medical societies: American Academy of Dermatology, Women's Dermatologic Society, American Society of Clinical Oncology, Society for Melanoma Research, Eastern Cooperative Oncology Group, American Medical Association, Pacific Dermatologic Association, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

References
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Large, violaceous nodule of Merkel cell carcinoma on the antecubital fossa. Courtesy of Dr. Jonathan Cook.
Histologic appearance of nodular Merkel cell carcinoma. Dermal nodule with a cohesive, expansile growth of basophilic cells.
High-power view demonstrates an open chromatin pattern and a high mitotic index.
Pseudorosette formation in Merkel cell carcinoma.
Merkel cell carcinoma with a focus of squamous differentiation.
Prominent in situ nested component of Merkel cell carcinoma, simulating malignant melanoma.
Electron micrograph of Merkel cell carcinoma showing a dense core granule (arrow).
Electron micrograph of Merkel cell carcinoma showing whorled bundles of intermediate filaments (arrow) near nucleus in Merkel cell carcinoma.
Dotlike paranuclear pattern of cytokeratin immunolocalization.
Table 1. Tumor Status
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis In situ primary tumor
T1 Primary tumor 2 cm or less in greatest dimension
T2 Primary tumor >2 cm but not >5 cm in greatest dimension
T3 Primary tumor >5 cm in greatest dimension
T4 Primary tumor invades bone, muscle, fascia, or cartilage
Table 2. Node Status
Nx Regional nodes cannot be assessed
N0 No regional node metastasis
cN0 Nodes not clinically detectable
cN1 Nodes clinically detectable
pN0 Nodes negative by pathologic examination
pNx Nodes not examined pathologically
N1a Micrometastasis
N1b Macrometastasis
N2 In-transit metastasis
Table 3. Metastasis Status
Mx Distant metastasis cannot be assessed
M0 No distant metastasis
M1 Distant metastasis
M1a Distant skin, distant subcutaneous tissues, or distant lymph nodes
M1b Lung
M1c All other visceral sites
Table 4. Stage Grouping
Stage Stage grouping
0 Tis N0 M0
IA T1 pN0 M0
IB T1 cN0 M0
IIA T2/T3 pN0 M0
IIB T2/T3 cN0 M0
IIC T4 N0 M0
IIIA Any T N1a M0
IIIB Any T N1b/N2 M0
IV Any T Any N M1
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