Skip to main content

Advertisement

Log in

Merkel cell carcinoma: What do we know about it and what should we do?

  • Educational Series
  • Advances in Translational Oncology
  • Published:
Clinical and Translational Oncology Aims and scope Submit manuscript

Abstract

Merkel cell carcinoma (MCC) is a rare primary cutaneous carcinoma of the skin that is highly aggressive, and has a high risk of locoregional and distant spread, a mortality rate considerably higher than that of cutaneous melanoma and poor survival. Its incidence has increased during the past twenty years. The studies published since 2008 have introduced changes in the understanding of its epidemiology and pathogenesis, and consequently the therapeutic approach. Despite this, there is still controversy surrounding its optimal management, which requires clarification. This is the purpose of this review.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Becker JC (2010) Merkel cell carcinoma (symposium article). Ann Oncol [Suppl 7]:vii81–vii85

    Article  Google Scholar 

  2. Wong HH, Wang J (2010) Merkel cell carcinoma. Arch Pathol Lab Med 134:1711–1716

    PubMed  Google Scholar 

  3. Toker C (1972) Trabecular carcinoma of the skin. Arch Dermatol 105:107–110

    Article  PubMed  CAS  Google Scholar 

  4. Hui AC, Stillie AL, Seel M et al (2011) Merkel cell carcinoma: 27-year experience at the Peter MacCallum Cancer Center. Int J Radiat Oncol Biol Phys 80:1430–1435

    Article  PubMed  Google Scholar 

  5. Becker JC, Kaukzok CS, Ugurel S et al (2008) Merkel cell carcinoma: molecular pathogenesis, clinical features and therapy. J Dtsch Dermatol Ges 6:709–719

    Article  PubMed  Google Scholar 

  6. Bobos M, Hytiroglou P, Kostopoulos et al (2006) Immunohistochemical distinction between Merkel cell carcinoma and small cell carcinoma of the lung. Am J Dermatopathol 28:99–104

    Article  PubMed  Google Scholar 

  7. Koljonen V, Kukko H, Tukiainen E et al (2009) Incidence of Merkel cell carcinoma in renal transplant recipients. Nephrol Dial Transplant Oct 1: 3231–3235

    Article  Google Scholar 

  8. Reichgelt B, Visser O (2011) Epidemiology and survival of Merkel cell carcinoma in the Netherlands. A population-based study of 808 cases in 1993–2007. Eur J Cancer 47:579–585

    Article  PubMed  CAS  Google Scholar 

  9. Zhan FQ, Sharon Packianathan VS, Zeitouni NC (2009) Merkel cell carcinoma: a review of current advances. J Natl Compr Canc Netw Mar 1: 333–339

    Google Scholar 

  10. Kaae J, Hansen AV, Biggar R et al (2010) Merkel cell carcinoma: incidence, mortality, and risk of other cancers. J Natl Cancer Inst 102:793–801

    Article  PubMed  Google Scholar 

  11. Brown JA, Smoller BR (2009) Merkel cell carcinoma: what is it, what will it do and where will it go? What role should the pathologist play in reporting this information? J Cutan Pathol 36: 924–927

    Article  PubMed  Google Scholar 

  12. Leonard JH, Williams G, Walters MK et al (1996) Deletion mapping of the short arm of chromosome 3 in Merkel cell carcinoma. Genes Chromosomes Cancer 15:102–107

    Article  PubMed  CAS  Google Scholar 

  13. Van Gele M, Kaghad M, Leonard JH et al (2000) Mutation analysis of p73 and TP53 in Merkel cell carcinoma. Br J Cancer 82:823–826

    Article  PubMed  Google Scholar 

  14. Bichakjian CK, Lowe L, Lao CD et al (2007) Merkel cell carcinoma: critical review with guidelines for multidisciplinary management. Cancer 110:1–12

    Article  PubMed  Google Scholar 

  15. Feng H, Shuda M, Chang Y et al (2008) Clonal integration of a polyomavirus in Merkel cell carcinoma. Science 319:1096–1099

    Article  PubMed  CAS  Google Scholar 

  16. Shuda M, Arora R, Kwun HJ et al (2009) Human Merkel cell polyomavirus infection I. MCV T antigen expression in Merkel cell carcinoma, lymphoid tissues and lymphoid tumors. Int J Cancer 125:1243–1249

    CAS  Google Scholar 

  17. Varga E, Kiss M, Szabo K et al (2009) Detection of Merkel cell polyomavirus DNA in Merkel cell carcinomas. Br J Dermatol 161:930–932

    Article  PubMed  CAS  Google Scholar 

  18. Sihto H, Kukko H, Koljonen V et al (2011) Merkel cell polyomavirus infection, large T antigen, retinoblastoma protein and outcome in Merkel cell carcinoma. Clin Cancer Res 15:4806–4813

    Article  Google Scholar 

  19. Ferringer T, Rogers HC, Metcalf JS (2005) Merkel cell carcinoma in situ. J Cutan Pathol 32:162–165

    Article  PubMed  Google Scholar 

  20. Satter EK, DeRienzo DP (2007) Synchronous onset of multiple cutaneous neuroendocrine (Merkel cell) carcinomas localized to the scalp. J Cutan Pathol 35:685–691

    Article  Google Scholar 

  21. Heath M, Jaimes N, Lemos B et al (2008) Clinical characteristics of Merkel cell carcinoma at diagnosis in 195 patients: the AEIOU features. J Am Acad Dermatol 58:375–381

    Article  PubMed  Google Scholar 

  22. Albores-Saavedra J, Batich K, Chable-Montero F et al (2010) Merkel cell carcinoma demographics, morphology, and survival based on 3870 cases: a population based study. J Cutan Pathol 37:20–27

    Article  PubMed  Google Scholar 

  23. Nicolaidou E, Mikrova A, Antoniuo C et al (2012) Advances in Merkel cell carcinoma pathogenesis and management: a recently discovered virus, and a new international consensus staging system and new diagnostic codes. Br J Dermatol 166:16–21

    Article  PubMed  CAS  Google Scholar 

  24. Leech SN, Kolar AJO, Barrett PD et al (2001) Merkel cell carcinoma can be distinguished from metastatic small cell carcinoma using antibodies to cytokeratin 20 and thyroid transcription factor 1. J Clin Pathol 54:727–729

    Article  PubMed  CAS  Google Scholar 

  25. Sidiropoulos M, Hanna W, Raphael SJ et al (2011) Expression of TdT in Merkel cell carcinoma and small cell lung carcinoma. Am J Clin Pathol 136: 831–838

    Article  Google Scholar 

  26. Sur M, AlArdati H, Ross C et al (2007) TdT expression in Merkel cell carcinoma: potential diagnostic pitfall with blastic hematological malignances and expanded immunohistochemical analysis. Mod Pathol 20:1113–1120

    Article  PubMed  CAS  Google Scholar 

  27. Iyer JG, Koba S, Nghiem P (2009) Toward better management of Merkel cell carcinoma using a consensus staging system, new diagnostic codes and recently discovered virus. Actas Dermosifiliogr 100:49–54

    Article  PubMed  Google Scholar 

  28. Pérez CA, Brady LW, Halperin EC (2008) Principles and practice of radiation oncology, 5th edn. Lippincott Williams and Wilkins. Philadelphia

    Google Scholar 

  29. Veness M, Howle J (2010) Patients with clinically node negative extremity Merkel cell carcinoma: the importance of identifying and treating patients with microscopic nodal metastases. Australasian J Dermatol 51:274–278

    Article  Google Scholar 

  30. Senchenkov A, Barnes SA, Moran SL (2007) Predictors of survival and recurrence in the surgical treatment of Merkel cell carcinoma of the extremities. J Surg Oncol 95:229–234

    Article  PubMed  Google Scholar 

  31. Gupta SG, Wang LC, Penas PF et al (2006) Sentinel lymph node biopsy for evaluation and treatment of patients with Merkel cell carcinoma. Arch Dermatol 142:685–690

    Article  PubMed  Google Scholar 

  32. Shnayder Y, Weed DT, Arnold DJ et al (2008) Management of the neck in Merkel cell carcinoma of the head and neck: University of Miami experience. Head Neck 30:1559–1565

    Article  PubMed  Google Scholar 

  33. Andea AA, Coit DG, Amin B et al (2008) Merkel cell carcinoma: histologic features and prognosis. Cancer 113:2549–2558

    Article  PubMed  Google Scholar 

  34. Golberg SR, Neifeld JP, Frable WJ (2007) Prognostic value of tumor thickness in patients with Merkel cell carcinoma. J Surg Oncol 95:618–622

    Article  Google Scholar 

  35. Mott RT, Smoller BR, Morgan MB (2004) Merkel cell carcinoma: a clinicopathologic study with prognostic implications. J Cutan Pathol 31:217–223

    Article  PubMed  Google Scholar 

  36. Fernández-Figueras MT, Puig L, Musulen et al (2005) Prognostic significance of p27Kip1, p45Skp2 and Ki67 expression profiles in Merkel cell carcinoma, extracutaneous small cell carcinoma, and cutaneous squamous cell carcinoma. Histopathology 46:614–621

    Article  PubMed  Google Scholar 

  37. Koljonen V, Tukiainen E, Haglund C et al (2006) Proliferative activity detected by Ki67 correlates with poor outcome in Merkel cell carcinoma. Histopathology 49:551–553

    Article  PubMed  CAS  Google Scholar 

  38. Schwartz JL, Griffith KA, Lowe L et al (2011) Features predicting sentinel lymph node positivity in Merkel cell carcinoma. J Clin Oncol 29:1036–1041

    Article  PubMed  Google Scholar 

  39. NCCN (2010) NCCN Clinical Practice Guidelines in Oncology. Available at: http://www.nccn.org/professionals/physicians_gls/f_guidelines.asp. Merkel cell carcinoma

    Google Scholar 

  40. Allen PJ, Bowne WB, Jaques DP et al (2005) Merkel cell carcinoma: prognosis and treatment of patients from a single institution. J Clin Oncol 23:2300–2309

    Article  PubMed  Google Scholar 

  41. Lemos BD, Storer BE, Iyer JG et al (2010) Pathologic nodal evaluation improves prognostic accuracy in Merkel cell carcinoma: analysis of 5823 casa as the basis of the first consensus staging system. J Am Acad Dermatol 63:751–761

    Article  PubMed  Google Scholar 

  42. Veness MJ, Perera L, McCourt J et al (2005) Merkel cell carcinoma: improved outcome with adjuvant radiotherapy. J Surg 75:275–281

    Google Scholar 

  43. Harris KM, Christodouleas JP, Frassica1 D et al (2010) The use of sentinel lymph node biopsy in localized Merkel cell carcinoma and implications for prophylactic regional nodal irradiation. Int J Radiat Oncol Biol Phys 78:s618

    Article  Google Scholar 

  44. Poulsen M (2010) Merkel cell carcinoma of the skin. Lancet Oncol 5:593–599

    Article  Google Scholar 

  45. Guitera-Rovel P, Lumbroso J, Gautier-Gougis MS et al (2001) Indium-Ill octreotide scintigraphy of Merkel cell carcinomas and their metastases. Ann Oncol 12:807–811

    Article  PubMed  CAS  Google Scholar 

  46. Gabriel M, Decristoforo C, Kendler D et al (2007) 68Ga-DOTA-Tyr3-Octeotride PET in neuroendocrine tumors: comparison with somatostatin receptor scintigraphy and CT. J Nuclear Med 48:508–518

    Article  CAS  Google Scholar 

  47. Durani BK, Klein A, Henze M et al (2003) Somatostatin analogue scintigraphy in Merkel cell tumours. Br J Dermatol 148:1135–1140

    Article  PubMed  CAS  Google Scholar 

  48. Foote M, Harvey J, Porceddu S et al (2010) Effect of radiotherapy dose and volume on relapse in Merkel cell cancer of the skin. Int J Radiat Oncol Biol Phys 77:677–684

    Article  PubMed  Google Scholar 

  49. Thomas CJ, Wood GC, Marks VJ (2007) Mohs micrographic surgery in the treatment of rare agressive cutaneous tumors: the Geisinger experience. Dermatol Surg 33:333–339

    Article  PubMed  CAS  Google Scholar 

  50. Median-Franco HU, Urist MM, Fiveash J et al (2001) Multimodality treatment of Merkel cell carcinoma: case series and literature review of 1024 cases. Ann Surg Oncol 8:204–208

    Article  Google Scholar 

  51. Morrison WH, Peters LJ, Silva EG et al (1990) The essential role of radiation therapy in securing locoregional control of cell carcinoma. Int J Radiat Oncol Biol Phys 19:583–591

    Article  PubMed  CAS  Google Scholar 

  52. Trombetta M, Packard M, Velosa C et al (2011) Merkel cell tumor of the skin treated with localized radiotherapy: are widely negative margins required. Rare Tumors 3:e12

    Article  PubMed  Google Scholar 

  53. Meeuwissen JA, Bourne R, Kearsley J (1995) The importance of postoperative radiation therapy in the treatment of Merkel cell carcinoma. Int J Radiat Oncol Biol Phys 30:325–331

    Article  Google Scholar 

  54. Mortier L, Mirabel X, Fournier C et al (2003) Radiotherapy alone for primary Merkel cell carcinoma. Arch Dermatol 139:1587–1590

    Article  PubMed  Google Scholar 

  55. Veness M, Foote M, Gebsky V et al (2010) The role of radiotherapy alone in patients with Merkel cell carcinoma: reporting the Australian experience of 43 patients. J Clin Oncol 78:703–709

    Google Scholar 

  56. Cotter SE, Devlin PM, Sahni D et al (2010) Treatment of cutaneous metastases of Merkel cell carcinoma with surface-mold computer-optimized high-dose-rate brachytherapy. J Clin Oncol 28: 464–466

    Article  Google Scholar 

  57. Kokoska ER, Kokoska MS, Collins BT et al (1997) Early aggressive treatment for Merkel cell carcinoma improves outcome. Am J Surg 174: 688–693

    Article  PubMed  CAS  Google Scholar 

  58. Mehrany K, Otley CC, Weenig RH et al (2002) A meta-analysis of the prognostic significance of sentinel lymph node status in Merkel cell carcinoma. Dermatol Surg 28:113–117

    Article  PubMed  Google Scholar 

  59. Fang LC, Lemos B, Douglas J et al (2010) Radiation monotherapy as regional treatment for lymph node-positive Merkel cell carcinoma. Cancer 116: 1783–1790

    Article  PubMed  Google Scholar 

  60. Bichakjian CK, Coit DG, Wong SL (2010) Radiation versus resection for Merkel cell carcinoma. Cancer 116:1620–1622

    Article  PubMed  Google Scholar 

  61. Clark JR, Veness MJ, Gilbert R et al (2007) Merkel cell carcinoma of the head and neck: is adjuvant radiotherapy necessary? Head Neck 29: 249–257

    Article  PubMed  Google Scholar 

  62. Mojica P, Smith D, Ellenhorn JDI (2011) Adjuvant radiation therapy is associated with improved survival in Merkel cell carcinoma of the skin. J Clin Oncol 25:1043–1047

    Article  Google Scholar 

  63. Poulsen MG, Rischin D, Porter I et al (2006) Does chemotherapy improve survival in high-risk stage I and II Merkel cell carcinoma of the skin? Int J Radiat Oncol Biol Phys 64:114–119

    Article  PubMed  Google Scholar 

  64. Poulsen M, Rischin D, Walpole E et al (2003) High-risk Merkel cell carcinoma of the skin treated with synchronous carboplatin/etoposide and radiation: a trans-Tasman Radiation Oncology Group Study-TROG 96:07. J Clin Oncol 21: 4371–4376

    Article  PubMed  CAS  Google Scholar 

  65. Jouary T, Leyral C, Dreno B et al (2011) Prophylactic regional radiotherapy versus observation in stage I Merkel cell carcinoma: a multicentric prospective randomized study. Ann Oncol 23:1074–1080

    Article  PubMed  Google Scholar 

  66. Becker J, Mauch C, Kortmann RD et al (2008) Short German guidelines: Merkel cell carcinoma. J Dtsch Dermatol Ges 6[Suppl 1]:s15–s16

    PubMed  Google Scholar 

  67. McNiff JM, Cowper SE, Lazova R et al (2005) Cd56 staining in Merkel cell carcinoma and natural killer-cell lymphoma: magic bullet, diagnostic pitfall, or both? J Cutan Pathol 32:541–545

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to José Pardo Masferrer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Muñoz, I.P., Masferrer, J.P., Vegas, J.O. et al. Merkel cell carcinoma: What do we know about it and what should we do?. Clin Transl Oncol 14, 401–412 (2012). https://doi.org/10.1007/s12094-012-0817-z

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12094-012-0817-z

Keywords

Navigation