RT Book, Section
A1 McEvoy, Aubriana
A1 Nghiem, Paul
A2 Kang, Sewon
A2 Amagai, Masayuki
A2 Bruckner, Anna L.
A2 Enk, Alexander H.
A2 Margolis, David J.
A2 McMichael, Amy J.
A2 Orringer, Jeffrey S.
SR Print(0)
ID 1161335584
T1 Merkel Cell Carcinoma
T2 Fitzpatrick's Dermatology, 9e
YR 2019
FD 2019
PB McGraw-Hill Education
PP New York, NY
SN 9780071837798
LK accessmedicine.mhmedical.com/content.aspx?aid=1161335584
RD 2024/04/19
AB AT-A-GLANCEThe  risk  of  death  from  Merkel  cell  carcinoma  (MCC)  is  2  to  3  times  higher  than  from  melanoma.Reported  incidence  of  MCC  quadrupled  from  1986  to  2006.Risk  factors  for  MCC  include  advanced  age,  immune  suppression,  and  fair  skin.Merkel  cell  polyomavirus  (MCPyV)  is  integrated  in  80%  of  MCC  cases.Consider  MCC  in  the  differential  diagnosis  of  any  rapidly  growing,  nontender  nodule  on  a  sun-exposed  area.Management  is  challenging  as  therapy  is  unique  and  controversial.Sentinel  lymph  node  biopsy,  surgery,  and  radiation  are  indicated  in  many  cases.Imaging  (CT,  MRI,  positron  emission  tomography)  has  poor  sensitivity  and  specificity  in  early  stages  of  MCC,  but  can  be  useful  in  assessment  of  and  surveillance  for  metastatic  disease.MCC  is  an  especially  radiosensitive  tumor.  Adjuvant  radiation  therapy  is  highly  effective,  and  overaggressive  surgery  should  be  avoided.  Radiation  monotherapy  is  an  important  and  effective  option  for  managing  disease  in  patients  who  are  not  candidates  for  surgery.Immune  therapies,  including  checkpoint  inhibition  and  T-cell  therapies  are  now  the  treatment  of  choice  for  advanced  disease.Chemotherapy  has  very  limited  utility  in  treating  MCC,  and  adjuvant  chemotherapy  is  not  beneficial.  Adjuvant  immune  therapy  is  an  area  of  new  research.Optimal  care  includes  multidisciplinary  coordination  between  dermatologists,  surgeons,  radiologists,  and  medical  oncologists  with  reference  to  the  National  Comprehensive  Cancer  Network  (NCCN)  guidelines.