Merkel cell carcinoma: How to prevent & treat it

Define

The characteristic tumor of Merkel cell carcinoma (MCC) often grows rapidly. Therefore, early recognition of signs and timely detection play an important role in improving prognosis. If metastasized, the disease can spread to distant organs such as the lungs, brain and bones.

Symptom

Lesions caused by MCC are often atypical, easily confused with other dermatological problems such as insect bites, cysts, styes or acne. The most prominent feature is often the rapid growth rate of the lesion.

MCC often appears on skin areas exposed to sunlight such as the face, head, and neck, but can also occur anywhere on the body.

Tumors often have the following characteristics:

• Appears on the face, head, neck or hands
• Hard, dome-shaped or raised
• Pink, red, reddish brown, purple or similar to skin color
• No pain
• Increases size rapidly in a few weeks to a few months
• May ulcerate and bleed

In light-skinned people, lesions are more common on the head and neck, while in darker-skinned people, lesions tend to appear on the legs.

Reason

MCC cancer occurs due to DNA mutations in cells that cause cells to proliferate uncontrollably. Some cases have been linked to Merkel cell polyomavirus, although the virus can exist on the skin of many people without causing disease.

Factors that increase the risk include:

• Excessive UV exposure (sunlight or tanning beds)
• Advanced age (average age of diagnosis is about 74)
• Immunodeficiency (HIV, blood diseases, use of immunosuppressive drugs)
• Light skin
• Men
• History of skin cancer

Diagnose

When skin lesions appear that tend to grow quickly, patients should see a doctor early for timely evaluation. Diagnosis of Merkel cell carcinoma is not based on blood tests, but mainly on clinical examination, medical history and especially skin biopsy – the “gold” standard to help determine the nature of the lesion.

To assess the spread of the disease, the doctor may prescribe additional methods such as lymph node biopsy and imaging techniques including X-ray, CT, MRI or PET.

Disease stage

MCC is divided into stages 0 to 4:

• Stage 0: Only in the superficial layer of skin
• Stage one: Tumor ≤ 2 cm, has not spread
• Stage two: Tumor gets larger or spreads to nearby tissue
• Stage three: Has spread to lymph nodes
• Stage four: Distant metastases

Treatment

Treatment depends on the size, location and extent of the tumor.

In the localization stageMerkel cell carcinoma is often treated with wide excision or Mohs surgery to completely remove the tumor. Radiation therapy may be prescribed adjuvantly after surgery to reduce the risk of recurrence. When the disease has spread to the lymph nodes, the patient may need lymph node dissection surgery combined with local treatments.

In case the disease recursthe treatment direction is generally similar to the first, often combined with surgery and radiotherapy.

In the metastatic stagesystemic treatment plays the main role, in which immunotherapy is the preferred choice with specialized treatment drugs. Chemotherapy is rarely used, only considered in cases where the disease progresses or does not respond to other methods.

Complications

MCC can metastasize to bones, lungs, brain, liver and also affect psychology (anxiety, depression).

Prevent

The disease cannot be completely prevented, but the risk can be reduced by:

• Limit exposure to UV rays
• Use sunscreen with SPF ≥ 30
• Avoid strong sunlight (10:00 a.m. – 3:00 p.m.)
• Self-examine your skin monthly
• Regular dermatological examination every year