Merkel Cell Carcinoma: Symptoms, Causes, Treatment

What are the symptoms of Merkel cell carcinoma?

Merkel cell carcinoma (MCC) is a rare and aggressive type of skin cancer that typically appears as a firm, painless nodule or tumor on the skin. The symptoms of MCC can vary depending on the location and size of the tumor, but common symptoms include:

1. Skin lesion: The most common symptom of MCC is a skin lesion or tumor that appears as a:
   • Firm, rubbery, or hard lump
   • Nodule or bump on the skin
   • Ulcerated lesion (open sore)
   • Discolored patch or plaque
2. Pain: Some people may experience pain or discomfort in the affected area, which can be mild or severe.
3. Itching: MCC lesions can cause itching or burning sensations in the affected area.
4. Bleeding: Some MCC lesions may bleed or ooze fluid.
5. Swelling: In some cases, MCC lesions can cause swelling in the surrounding tissue.
6. Metastasis: In advanced stages, MCC can spread to lymph nodes and other parts of the body, leading to symptoms such as:
   • Swollen lymph nodes in the neck, armpits, or groin
   • Fever
   • Weight loss
   • Fatigue
   • Difficulty breathing
7. Other symptoms: In rare cases, MCC can cause other symptoms such as:
   • Eye problems (e.g., eyelid swelling, vision changes)
   • Facial paralysis
   • Hearing loss
   • Seizures

It’s essential to note that MCC can occur anywhere on the body, but it most commonly affects areas exposed to the sun, such as the face, head, neck, and hands.

Early detection and treatment of MCC are crucial for improving outcomes and reducing mortality rates. If you notice any unusual skin changes or symptoms, consult a dermatologist or healthcare provider for evaluation and diagnosis.

What are the causes of Merkel cell carcinoma?

Merkel cell carcinoma (MCC) is a rare and aggressive type of skin cancer that is believed to be caused by a combination of genetic and environmental factors. Here are some of the known causes and risk factors for MCC:

1. UV radiation: Exposure to ultraviolet (UV) radiation from the sun or tanning beds is a significant risk factor for MCC. Prolonged exposure to UV radiation can cause DNA damage, which can lead to the development of cancer.
2. Genetic mutations: MCC is often associated with genetic mutations in the TRK-F family of genes, which encode proteins involved in cell signaling and cell growth regulation.
3. Human papillomavirus (HPV): Some studies suggest that HPV may play a role in the development of MCC, particularly HPV-8 and HPV-17.
4. Immunosuppression: People with weakened immune systems, such as those with organ transplants or HIV/AIDS, are at higher risk of developing MCC.
5. Age: MCC is more common in older adults, with the majority of cases occurring in people over the age of 50.
6. Gender: MCC is more common in men than women, with a male-to-female ratio of approximately 2:1.
7. Family history: Having a family history of MCC or other types of skin cancer may increase an individual’s risk of developing the disease.
8. Occupational exposure: People who work outdoors or have occupations that involve exposure to UV radiation, such as farmers, construction workers, or outdoor laborers, may be at higher risk of developing MCC.
9. Previous skin cancer: People who have had previous skin cancers, particularly squamous cell carcinoma or basal cell carcinoma, may be at higher risk of developing MCC.

It’s essential to note that MCC is a rare disease, and most people do not develop it. If you are concerned about your risk factors or have any symptoms, consult a dermatologist or healthcare provider for evaluation and guidance.

How is the diagnosis of Merkel cell carcinoma made?

The diagnosis of Merkel cell carcinoma (MCC) typically involves a combination of clinical evaluation, imaging studies, and pathology examination. Here are the steps involved in making a diagnosis of MCC:

1. Clinical evaluation: A healthcare provider will conduct a thorough physical examination to assess the patient’s overall health and examine the affected skin area.
2. Imaging studies:
   • X-rays: X-rays may be used to evaluate the extent of the tumor and detect any lymph node involvement.
   • Computed Tomography (CT) scan: CT scans can provide detailed images of the tumor and surrounding tissues.
   • Magnetic Resonance Imaging (MRI): MRI scans can help evaluate the tumor’s size, shape, and location.
3. Biopsy: A biopsy is a procedure in which a sample of tissue is removed from the affected skin area for examination under a microscope.
   • Punch biopsy: A small, circular piece of skin is removed using a specialized tool.
   • Excisional biopsy: The entire tumor is removed, along with some surrounding tissue, to ensure that all cancerous cells are removed.
4. Pathology examination: The removed tissue sample is examined by a pathologist to determine the presence and characteristics of cancer cells.
   • Histopathology: The pathologist examines the tissue sample under a microscope to look for characteristic features of MCC, such as:
     • Sheets of atypical cells
     • Large cells with abundant cytoplasm
     • Nuclear atypia
5. Immunohistochemistry: Additional testing may be performed to confirm the diagnosis, including immunohistochemistry (IHC), which involves staining the tissue sample with specific antibodies to detect proteins associated with MCC.
6. Molecular testing: Molecular testing may be performed to identify genetic mutations or other molecular changes associated with MCC.

If you suspect you have Merkel cell carcinoma or have concerns about your skin health, consult a dermatologist or healthcare provider for evaluation and guidance. Early detection and treatment can improve outcomes and reduce mortality rates.

What is the treatment for Merkel cell carcinoma?

The treatment for Merkel cell carcinoma (MCC) typically involves a combination of surgery, radiation therapy, and systemic therapy. The choice of treatment depends on the stage and location of the cancer, as well as the patient’s overall health. Here are some common treatments for MCC:

1. Surgery: Surgery is often the primary treatment for MCC. The goal is to remove the tumor and surrounding tissue to ensure that all cancerous cells are removed.
   • Wide local excision: A wide excision of the tumor and surrounding tissue is usually performed to remove all cancerous cells.
   • Mohs surgery: Mohs surgery is a specialized surgical technique that involves removing thin layers of tissue until all cancerous cells are removed.
2. Radiation therapy: Radiation therapy can be used in combination with surgery or as a standalone treatment for MCC.
   • External beam radiation therapy: This type of radiation therapy uses high-energy beams from a machine to target the tumor.
   • Brachytherapy: Brachytherapy involves placing small radioactive implants or seeds near the tumor to deliver radiation directly to the area.
3. Systemic therapy: Systemic therapy can be used to treat MCC that has spread to other parts of the body.
   • Chemotherapy: Chemotherapy involves using medication to kill cancer cells throughout the body.
   • Immunotherapy: Immunotherapy uses the body’s immune system to fight cancer cells. This can include checkpoint inhibitors, monoclonal antibodies, or adoptive T-cell therapy.
4. Targeted therapy: Targeted therapy is a type of treatment that targets specific genetic mutations or proteins associated with MCC.
   • Avelumab: Avelumab is a targeted therapy that targets PD-L1, a protein that helps cancer cells evade the immune system.
5. Cryotherapy: Cryotherapy involves using liquid nitrogen to freeze and kill cancer cells.

It’s essential to consult a dermatologist or healthcare provider for personalized treatment recommendations based on your specific case and stage of cancer.