1
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Dennis LK, Brown HE, Arrington AK. Comparison of Prognostic Factors for Merkel Cell Carcinoma, Mucosal Melanoma and Cutaneous Malignant Melanoma: Insights into Their Etiologies. Curr Oncol 2023; 30:3974-3988. [PMID: 37185414 PMCID: PMC10136436 DOI: 10.3390/curroncol30040301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/26/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
Little is known about the epidemiology of Merkel cell carcinoma (MCC) and mucosal melanoma (MM). Using the United States (US) National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program data, we compared MCC and MM with cutaneous malignant melanoma (CMM) with respect to incidence rates and prognostic factors to better understand disease etiologies. We describe the proportional incidences of the three cancers along with their survival rates based on 20 years of national data. The incidence rates in 2000–2019 were 203.7 per 1,000,000 people for CMM, 5.9 per 1,000,000 people for MCC and 0.1 per 1,000,000 people for MM. The rates of these cancers increased over time, with the rate of MM tripling between 2000–2009 and 2010–2019. The incidences of these cancers increased with age and rates were highest among non-Hispanic Whites. Fewer MCCs and MMS were diagnosed at the local stage compared with CMM. The cases in the 22 SEER registries in California were not proportional to the 2020 population census but instead were higher than expected for CMM and MCC and lower than expected for MM. Conversely, MM rates were higher than expected in Texas and New York. These analyses highlight similarities in the incidence rates of CMM and MCC—and differences between them and MM rates—by state. Understanding more about MCC and MM is important because of their higher potential for late diagnosis and metastasis, which lead to poor survival.
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Affiliation(s)
- Leslie K. Dennis
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA
| | - Heidi E. Brown
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA
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2
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Spada F, Bossi P, Caracò C, Sileni VC, Dei Tos AP, Fazio N, Grignani G, Maio M, Quaglino P, Queirolo P, Ascierto PA. Nationwide multidisciplinary consensus on the clinical management of Merkel cell carcinoma: a Delphi panel. J Immunother Cancer 2022; 10:jitc-2022-004742. [PMID: 35701070 PMCID: PMC9198700 DOI: 10.1136/jitc-2022-004742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 11/04/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare and highly aggressive cutaneous neuroendocrine carcinoma. The MCC incidence rate has rapidly grown over the last years, with Italy showing the highest increase among European countries. This malignancy has been the focus of active scientific research over the last years, focusing mainly on pathogenesis, new therapeutic trials and diagnosis. A national expert board developed 28 consensus statements that delineated the evolution of disease management and highlighted the paradigm shift towards the use of immunological strategies, which were then presented to a national MCC specialists panel for review. Sixty-five panelists answered both rounds of the questionnaire. The statements were divided into five areas: a high level of agreement was reached in the area of guidelines and multidisciplinary management, even if in real life the multidisciplinary team was not always represented by all the specialists. In the diagnostic pathway area, imaging played a crucial role in diagnosis and initial staging, planning for surgery or radiation therapy, assessment of treatment response and surveillance of recurrence and metastases. Concerning diagnosis, the usefulness of Merkel cell polyomavirus is recognized, but the agreement and consensus regarding the need for cytokeratin evaluation appears greater. Regarding the areas of clinical management and follow-up, patients with MCC require customized treatment. There was a wide dispersion of results and the suggestion to increase awareness about the adjuvant radiation therapy. The panelists unanimously agreed that the information concerning avelumab provided by the JAVELIN Merkel 200 study is adequate and reliable and that the expanded access program data could have concrete clinical implications. An immunocompromised patient with advanced MCC can be treated with immunotherapy after multidisciplinary risk/benefit assessment, as evidenced by real-world analysis and highlighted in the guidelines. A very high consensus regarding the addition of radiotherapy to treat the ongoing focal progression of immunotherapy was observed. This paper emphasizes the importance of collaboration and communication among the interprofessional team members and encourages managing patients with MCC within dedicated multidisciplinary teams. New insights in the treatment of this challenging cancer needs the contribution of many and different experts.
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Affiliation(s)
- Francesca Spada
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology (IEO) IRCCS, Milano, Italy
| | - Paolo Bossi
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health-Medical Oncology, University of Brescia, ASST-Spedali Civili, Brescia, Italy
| | - Corrado Caracò
- Melanoma and Skin Cancers Surgery Unit, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Napoli, Italy
| | | | | | - Nicola Fazio
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology (IEO) IRCCS, Milano, Italy
| | - Giovanni Grignani
- Division of Medical Oncology, Candiolo Cancer Institute FPO IRCCS, Candiolo, Italy
| | - Michele Maio
- Center for Immuno-Oncology, Department of Oncology, University Hospital of Siena, Siena, Italy
| | - Pietro Quaglino
- Dermatologic Clinic, Department of Medical Sciences, University of Turin, Torino, Italy
| | - Paola Queirolo
- Melanoma and Sarcoma Medical Treatment, European Institute of Oncology (IEO), Milano, Italy
| | - Paolo Antonio Ascierto
- Melanoma Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione "G.Pascale", Napoli, Italy
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3
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Mistry K, Levell NJ, Craig P, Steven NM, Venables ZC. Merkel cell carcinoma. SKIN HEALTH AND DISEASE 2021; 1:e55. [PMID: 35663768 PMCID: PMC9060125 DOI: 10.1002/ski2.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/25/2021] [Accepted: 06/07/2021] [Indexed: 11/10/2022]
Abstract
Merkel cell carcinoma (MCC) is a rare neuroendocrine carcinoma. The cellular origin of MCC may include Merkel cell precursors. The incidence of MCC has increased significantly however trends may have been confounded by evolving diagnostic criteria. The two key aetiologies of MCC are ultraviolet radiation and Merkel cell polyoma virus (MCPyV). Both have unique mechanisms of carcinogenesis. MCC presents non-specifically as a rapidly growing, red-to-violet nodule on sun-exposed areas. Diagnostic accuracy has improved through immunohistochemical markers such as CK-20. Lymph nodes should be evaluated in MCC through examination and sentinel biopsy. USS, CT, MRI and CT-PET may be useful in staging. Management depends on tumour location, stage and comorbidities. MCPyV status may guide treatment strategy in the future. Treatment for the primary MCC is commonly wide local excision followed by radiotherapy, guided by anatomical constraints. There is uncertainty about surgical margins. Treatments for nodal disease have not been determined through trials. They include nodal dissection or radiotherapy for clinically or radiologically apparent disease, and adjuvant nodal irradiation for negative nodes, microscopic disease or following nodal dissection for definite disease. Patients with loco-regional advanced inoperable disease should be considered for combination therapy including chemotherapy, radiotherapy, surgery and immunotherapy. Systemic therapy for advanced disease includes immune checkpoint inhibitors targeting the PD-1/PD-L1 pathway. Avelumab can improve survival in metastatic MCC. Immunotherapy may result in longer disease control. Various other immunotherapeutic and molecular agents are undergoing trials. MCC continues to have a high mortality characterized by high recurrence and early metastases.
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Affiliation(s)
- K. Mistry
- Department of DermatologyNorfolk and Norwich University HospitalNorwichUK
| | - N. J. Levell
- Department of DermatologyNorfolk and Norwich University HospitalNorwichUK
| | - P. Craig
- Department of Cellular PathologyGloucestershire Hospitals NHS Foundation TrustCheltenhamUK
| | - N. M. Steven
- Institute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUK
| | - Z. C. Venables
- Department of DermatologyNorfolk and Norwich University HospitalNorwichUK
- Public Health EnglandVictoria House Capital ParkCambridgeUK
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4
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Tintila A, Doroftei B, Grab D, Simionescu G, Anton E, Maftei R, Ilea C, Anton C. Importance of studying primitive neuroectodermal tumors and extraosseous Ewings sarcoma of the vagina and vulva. Oncol Lett 2021; 21:171. [PMID: 33552288 DOI: 10.3892/ol.2021.12432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/11/2020] [Indexed: 11/06/2022] Open
Abstract
Primitive neuroectodermal tumor (PNT) and Ewing's sarcoma are rare, round-cell tumors, characterized by the presence of the t(11; 22)(q24; q12) chromosomal translocation. A review of the literature revealed only 38 previously reported cases of vulvar PNT and Ewing's sarcoma and 15 vaginal PNT and Ewing's sarcoma. Although rare, these types of tumors should be taken into consideration when making a differential diagnosis for vulvar or vaginal tumors. The currently available data is limited, and therefore, case reports are essential for improving knowledge and management of these types of extremely rare tumors. However, further molecular and histopathological studies are essential for an improved understanding of these conditions and for an early, correct diagnosis. Although the gathered and presented data from the present review are limited, the literature demonstrates that the outcome of these types of cancer are more favorable compared with outcomes observed for carcinomas in more typical locations.
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Affiliation(s)
- Adeline Tintila
- Clinical Department, Spitalul Judetean Suceava, Suceava 720224, Romania
| | - Bogdan Doroftei
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy 'Grigore T. Popa', Iasi 700115, Romania.,Clinical Department, Clinical Hospital of Obstetrics and Gynecology 'Cuza Voda', Iasi 700038, Romania.,Clinical Department, Origyn Fertility Center, Iasi 700032, Romania
| | - Delia Grab
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy 'Grigore T. Popa', Iasi 700115, Romania.,Clinical Department, Clinical Hospital of Obstetrics and Gynecology 'Cuza Voda', Iasi 700038, Romania
| | - Gabriela Simionescu
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy 'Grigore T. Popa', Iasi 700115, Romania.,Clinical Department, Clinical Hospital of Obstetrics and Gynecology 'Cuza Voda', Iasi 700038, Romania.,Clinical Department, Origyn Fertility Center, Iasi 700032, Romania
| | - Emil Anton
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy 'Grigore T. Popa', Iasi 700115, Romania.,Clinical Department, Clinical Hospital of Obstetrics and Gynecology 'Cuza Voda', Iasi 700038, Romania
| | - Radu Maftei
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy 'Grigore T. Popa', Iasi 700115, Romania
| | - Ciprian Ilea
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy 'Grigore T. Popa', Iasi 700115, Romania.,Clinical Department, Clinical Hospital of Obstetrics and Gynecology 'Cuza Voda', Iasi 700038, Romania
| | - Carmen Anton
- Clinical Department, Sf. Spiridon Clinical Hospital, Iasi 700111, Romania.,Department of Gastroenterology, University of Medicine and Pharmacy 'Grigore T. Popa', Iasi 700115, Romania
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5
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Xia Y, Cao D, Zhao J, Zhu B, Xie J. Clinical Features and Prognosis of Merkel Cell Carcinoma in Elderly Patients. Med Sci Monit 2020; 26:e924570. [PMID: 32653892 PMCID: PMC7375029 DOI: 10.12659/msm.924570] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/28/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Merkel cell carcinoma (MCC) occurs primarily among elderly patients over 70 years old, but the ability to predict the prognosis of these elderly patients is poor. This population-based study aimed to identify prognostic risk factors for elderly patients with MCC. MATERIAL AND METHODS The survival and disease information of MCC patients age 65 years or older was downloaded from the SEER database, and all data were split into 2 groups based on age 80 years, with overall survival and MCC-specific survival as the main outcome indicators. RESULTS Application of the inclusion criteria yielded 1973 patients with MCC, of whom 55.6% were age 65-80 years. Among them, 1258 were males, accounting for 63.8%. In survival analysis, factors that were significantly correlated with overall survival and MCC-specific survival were N stage, M stage, liver metastasis, and lymph node surgery. CONCLUSIONS We provide epidemiological insights into Merkel cell carcinoma in elderly patients and confirmed that patients receiving lymph node surgery have better outcomes. To the best of our knowledge, this is the first study to show that the occurrence of liver metastasis is associated with poor prognosis. Our results will help strengthen monitoring of the liver condition of elderly patients and to perform necessary lymph node surgery within the patient's tolerance.
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Affiliation(s)
- YiJun Xia
- Department of Plastic Surgery, Anhui Medical University, Hefei, Anhui, P.R. China
| | - DongSheng Cao
- Department of Plastic Surgery, Anhui Medical University, Hefei, Anhui, P.R. China
| | - Jun Zhao
- Department of Dermatology, Anhui Medical University, Hefei, Anhui, P.R. China
| | - BangZhong Zhu
- Department of Plastic Surgery, Anhui Medical University, Hefei, Anhui, P.R. China
| | - Juan Xie
- Department of Plastic Surgery, Anhui Medical University, Hefei, Anhui, P.R. China
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6
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Rastrelli M, Del Fiore P, Buja A, Vecchiato A, Rossi CR, Chiarion Sileni V, Tropea S, Russano F, Zorzi M, Spina R, Cappellesso R, Mazzarotto R, Cavallin F, Bassetto F, Bezzon E, Ferrazzi B, Alaibac M, Mocellin S. A Therapeutic and Diagnostic Multidisciplinary Pathway for Merkel Cell Carcinoma Patients. Front Oncol 2020; 10:529. [PMID: 32351898 PMCID: PMC7174780 DOI: 10.3389/fonc.2020.00529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 03/25/2020] [Indexed: 12/19/2022] Open
Abstract
Merkel Cell Carcinoma (MCC) is a highly aggressive neuroendocrine neoplasm of the skin. Due to its rarity, the management of MCC is not standardized across centers. In this article, we present the experience of the Veneto region in the North-East of Italy, where a committee of skin cancer experts has proposed a clinical pathway for the diagnosis and treatment of MCC. Putting together the evidence available in the international literature, we outlined the best approach to the management of patients affected with this malignancy step- by- step for each possible clinical situation. Crucial in this pathway is the role of the multidisciplinary team to deal with the lack of robust information on each aspect of the management of this disease.
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Affiliation(s)
- Marco Rastrelli
- Surgical Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Paolo Del Fiore
- Surgical Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Alessandra Buja
- Department of Cardiological, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Antonella Vecchiato
- Surgical Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Carlo Riccardo Rossi
- Surgical Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy.,Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
| | | | - Saveria Tropea
- Surgical Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Francesco Russano
- Surgical Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Manuel Zorzi
- Veneto Tumour Registry, Azienda Zero, Padua, Italy
| | - Romina Spina
- Surgical Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Rocco Cappellesso
- Surgical Pathology and Cytopathology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Renzo Mazzarotto
- Department of Surgery and Oncology, Unit of Radiotherapy, Hospital Trust of Verona, Verona, Italy
| | | | - Franco Bassetto
- Clinic of Plastic Surgery, Department of Neuroscience, Padua University Hospital, University of Padua, Padua, Italy
| | - Elisabetta Bezzon
- Radiology Unit, Department of Imaging and Medical Physics, Istituto Oncologico Veneto IOV IRCSS, Padua, Italy
| | - Beatrice Ferrazzi
- Postgraduate School of Occupational Medicine, University of Verona, Verona, Italy
| | - Mauro Alaibac
- Unit of Dermatology, University of Padua, Padua, Italy
| | - Simone Mocellin
- Surgical Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy.,Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
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7
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García-Oriola G, Real-Peña L, Pastor-Escartín F, Talamantes-Escribá F. Merkel cell carcinoma spinal metastases in an immunosuppressed patient: Clinical case. Neurocirugia (Astur) 2020; 32:44-48. [PMID: 32234286 DOI: 10.1016/j.neucir.2020.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/23/2020] [Accepted: 01/30/2020] [Indexed: 11/26/2022]
Abstract
Merkel cell carcinoma is a rare epidermal malignant tumor arised from neuroendocrine epidermal cells, called Merkel cells. Prognosis is poor when tumor spreads to distant locations. Among metastases sites, spinal is not frequent at all and its management remains controversial. We present the second reported case of spinal metastases from Merkel cell carcinoma in an immunosuppressed patient.
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Affiliation(s)
- Guillermo García-Oriola
- Servicio de Neurocirugía, Hospital Clínico Universitario de Valencia. Universidad de Valencia, Valencia, España.
| | - Luis Real-Peña
- Servicio de Neurocirugía, Hospital Clínico Universitario de Valencia. Universidad de Valencia, Valencia, España
| | - Félix Pastor-Escartín
- Servicio de Neurocirugía, Hospital Clínico Universitario de Valencia. Universidad de Valencia, Valencia, España
| | - Fernando Talamantes-Escribá
- Servicio de Neurocirugía, Hospital Clínico Universitario de Valencia. Universidad de Valencia, Valencia, España
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8
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Schmerling RA, Casas JG, Cinat G, Ospina FEG, Kassuga LEBP, Tlahuel JLM, Mazzuoccolo LD. Burden of Disease, Early Diagnosis, and Treatment of Merkel Cell Carcinoma in Latin America. J Glob Oncol 2019; 4:1-11. [PMID: 30085832 PMCID: PMC6223512 DOI: 10.1200/jgo.18.00041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Rafael A Schmerling
- Rafael A. Schmerling, Beneficiência Portugesa de São Paulo, São Paulo; Luiza E.B.P. Kassuga, National Cancer Institute, Rio de Janeiro, Brazil; Jose G. Casas, Hospital Alemán de Buenos Aires; Gabriela Cinat, University of Buenos Aires; Luis Daniel Mazzuoccolo, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Fabio Ernesto Grosso Ospina, Centro Nacional de Oncología de Colombia, Bogotá, Colombia; and Jorge Luis Martinez Tlahuel, National Cancer Institute, Mexico City, Mexico
| | - Jose G Casas
- Rafael A. Schmerling, Beneficiência Portugesa de São Paulo, São Paulo; Luiza E.B.P. Kassuga, National Cancer Institute, Rio de Janeiro, Brazil; Jose G. Casas, Hospital Alemán de Buenos Aires; Gabriela Cinat, University of Buenos Aires; Luis Daniel Mazzuoccolo, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Fabio Ernesto Grosso Ospina, Centro Nacional de Oncología de Colombia, Bogotá, Colombia; and Jorge Luis Martinez Tlahuel, National Cancer Institute, Mexico City, Mexico
| | - Gabriela Cinat
- Rafael A. Schmerling, Beneficiência Portugesa de São Paulo, São Paulo; Luiza E.B.P. Kassuga, National Cancer Institute, Rio de Janeiro, Brazil; Jose G. Casas, Hospital Alemán de Buenos Aires; Gabriela Cinat, University of Buenos Aires; Luis Daniel Mazzuoccolo, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Fabio Ernesto Grosso Ospina, Centro Nacional de Oncología de Colombia, Bogotá, Colombia; and Jorge Luis Martinez Tlahuel, National Cancer Institute, Mexico City, Mexico
| | - Fabio Ernesto Grosso Ospina
- Rafael A. Schmerling, Beneficiência Portugesa de São Paulo, São Paulo; Luiza E.B.P. Kassuga, National Cancer Institute, Rio de Janeiro, Brazil; Jose G. Casas, Hospital Alemán de Buenos Aires; Gabriela Cinat, University of Buenos Aires; Luis Daniel Mazzuoccolo, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Fabio Ernesto Grosso Ospina, Centro Nacional de Oncología de Colombia, Bogotá, Colombia; and Jorge Luis Martinez Tlahuel, National Cancer Institute, Mexico City, Mexico
| | - Luiza E B P Kassuga
- Rafael A. Schmerling, Beneficiência Portugesa de São Paulo, São Paulo; Luiza E.B.P. Kassuga, National Cancer Institute, Rio de Janeiro, Brazil; Jose G. Casas, Hospital Alemán de Buenos Aires; Gabriela Cinat, University of Buenos Aires; Luis Daniel Mazzuoccolo, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Fabio Ernesto Grosso Ospina, Centro Nacional de Oncología de Colombia, Bogotá, Colombia; and Jorge Luis Martinez Tlahuel, National Cancer Institute, Mexico City, Mexico
| | - Jorge Luis Martinez Tlahuel
- Rafael A. Schmerling, Beneficiência Portugesa de São Paulo, São Paulo; Luiza E.B.P. Kassuga, National Cancer Institute, Rio de Janeiro, Brazil; Jose G. Casas, Hospital Alemán de Buenos Aires; Gabriela Cinat, University of Buenos Aires; Luis Daniel Mazzuoccolo, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Fabio Ernesto Grosso Ospina, Centro Nacional de Oncología de Colombia, Bogotá, Colombia; and Jorge Luis Martinez Tlahuel, National Cancer Institute, Mexico City, Mexico
| | - Luis Daniel Mazzuoccolo
- Rafael A. Schmerling, Beneficiência Portugesa de São Paulo, São Paulo; Luiza E.B.P. Kassuga, National Cancer Institute, Rio de Janeiro, Brazil; Jose G. Casas, Hospital Alemán de Buenos Aires; Gabriela Cinat, University of Buenos Aires; Luis Daniel Mazzuoccolo, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Fabio Ernesto Grosso Ospina, Centro Nacional de Oncología de Colombia, Bogotá, Colombia; and Jorge Luis Martinez Tlahuel, National Cancer Institute, Mexico City, Mexico
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9
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Fernández-Regueiro R, Suárez-Sánchez F, Morís-de la-Tassa J. Merkel cell carcinoma. Report of a case with an atypical location and presentation. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019. [DOI: 10.1016/j.recote.2019.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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10
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Carcinoma de células de Merkel: diagnóstico y tratamiento en atención especializada dermatológica. Guía de práctica clínica de la Academia Española de Dermatología y Venerología. ACTAS DERMO-SIFILIOGRAFICAS 2019; 110:460-468. [DOI: 10.1016/j.ad.2019.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/19/2019] [Accepted: 01/22/2019] [Indexed: 12/30/2022] Open
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11
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Doval JV, Cussac BL, Bustillo AP, Morena SPDL, González MF, Figueras MF, Villanueva M, Salas NR, Descalzo-Gallego M, García-Doval I, Ríos-Buceta L. Diagnosis and Treatment of Merkel Cell Carcinoma in Specialized Dermatology Units: A Clinical Practice Guideline of the Spanish Academy of Dermatology and Venereology. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2019.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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12
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Merkel cell carcinoma. Report of a case with an atypical location and presentation. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019; 63:313-315. [PMID: 31072794 DOI: 10.1016/j.recot.2019.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 11/14/2018] [Accepted: 01/07/2019] [Indexed: 11/24/2022] Open
Abstract
Merkel cell tumour is a rare skin tumour of high malignancy, poor prognosis and low survival. It is characterized by its tendency to lymph node and vascular invasion and by a high percentage of locoregional recurrence in the year following surgical removal. It affects adults between 60 and 80 years of age and often occurs in the head and neck. We present the case of an 85-year-old man presenting with an ulcerated gluteal mass of 4 months' evolution. Diagnosis was by histopathological and immunohistochemical study. Early diagnosis and appropriate treatment are important to improve the prognosis of these patients.
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13
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Becker JC, Eigentler T, Frerich B, Gambichler T, Grabbe S, Höller U, Klumpp B, Loquai C, Krause-Bergmann A, Müller-Richter U, Pföhler C, Schneider-Burrus S, Stang A, Terheyden P, Ugurel S, Veith J, Mauch C. S2k guidelines for Merkel cell carcinoma (MCC, neuroendocrine carcinoma of the skin) - update 2018. J Dtsch Dermatol Ges 2019; 17:562-576. [PMID: 31056838 DOI: 10.1111/ddg.13841] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Merkel cell carcinoma (MCC, ICD-O M8247 / 3) is a rare malignant primary skin tumor with epithelial and neuroendocrine differentiation. The neoplastic cells share many morphological, immunohistochemical and ultrastructural characteristics with Merkel cells of the skin. The diagnosis of MCC is rarely made on clinical grounds. Histological and immunohistochemical studies are usually required to confirm the clinical suspicion. Given the frequent occurrence of occult lymph node metastasis, sentinel lymph node biopsy should be performed once distant metastasis has been ruled out by cross-sectional imaging. Primary tumors without evidence of organ metastases are treated with complete surgical excision with appropriate surgical margins. Radiation therapy should be considered at all stages of the disease. For advanced MCC that is no longer amenable to curative treatment by surgery or radiation therapy, there is currently no established systemic therapy for which an improvement in recurrence-free survival or overall survival has been demonstrated in a prospective randomized trial. However, immunotherapy using PD-1/PD-L1 blockade seems to be superior to chemotherapy. Various factors warrant that further diagnostic and therapeutic interventions be determined by an interdisciplinary tumor board. These factors include the tumor's aggressiveness, the frequent indication for sentinel lymph node biopsy along with the frequent occurrence in the head and neck region, the potential indication for adjuvant radiation therapy as well as the complexity of the required diagnostic workup.
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Affiliation(s)
- Jürgen C Becker
- Department of Dermatology, Essen University Medical Center, Essen, Germany.,Translational Skin Cancer Research, German Cancer Consortium (DKTK).,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Eigentler
- Department of Dermatology, Tübingen University Medical Center, Tübingen, Germany
| | - Bernhard Frerich
- Department of Oral and Maxillofacial Plastic Surgery, Rostock University Medical Center, Rostock, Germany
| | - Thilo Gambichler
- Department of Dermatology, Bochum University Medical Center, Bochum, Germany
| | - Stephan Grabbe
- Department of Dermatology, Mainz University Medical Center, Mainz, Germany
| | | | - Bernhard Klumpp
- Department of Radiology, Tübingen University Medical Center, Tübingen, Germany
| | - Carmen Loquai
- Department of Dermatology, Mainz University Medical Center, Mainz, Germany
| | | | - Urs Müller-Richter
- Department of Oral and Maxillofacial Plastic Surgery, Würzburg University Medical Center, Würzburg, Germany
| | - Claudia Pföhler
- Department of Dermatology, Saarland University Medical Center, Homburg, Germany
| | | | - Andreas Stang
- Center of Clinical Epidemiology, Institute of Medical Informatics, Biometry and Epidemiology, Essen University Medical Center, Essen, Germany
| | | | - Selma Ugurel
- Department of Dermatology, Essen University Medical Center, Essen, Germany
| | - Johannes Veith
- Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - Cornelia Mauch
- Department of Dermatology, Cologne University Medical Center, Cologne, Germany
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14
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Abstract
Merkel cell carcinoma is a rare, highly aggressive skin tumor with neuroendocrine features found in older people. The pathogenesis is associated with immunosuppression, chronic UV light exposure and the Merkel cell polyomavirus. Clinically, Merkel cell carcinoma presents as a solitary, cutaneous or subcutaneous, red to bluish node. Due to early lymphogenic metastasis, locoregional metastases are already present in approximately 30% of cases at the time of diagnosis. The frequent local recurrences as well as the regional and distant metastases usually appear within the first 2-3 years after the initial diagnosis. The first treatment after diagnosis consists of complete surgical removal of the primary tumor with wide safety margins as well as a sentinel lymph node biopsy. Subsequently, adjuvant irradiation of the primary site should be performed. By additional radiotherapy of the regional lymph node stations, the rate of locoregional recurrence can be reduced. For systemic therapy of advanced Merkel cell carcinoma checkpoint inhibitors targeted against the PD-1/PD-L1 axis have proven to be highly and durably effective. In contrast the formerly frequently used chemotherapy shows moderate to good response rates but they are as a rule very short-lived.
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15
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Ha NH, Kim SK, Shin YS, Kim SM. Primary Merkel cell carcinoma of the earlobe in a young healthy man. Arch Craniofac Surg 2018; 19:205-209. [PMID: 30282431 PMCID: PMC6177680 DOI: 10.7181/acfs.2018.01858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/17/2018] [Indexed: 11/25/2022] Open
Abstract
Merkel cell carcinoma (MCC) is an uncommon neuroendocrine cutaneous tumor with poor prognosis. It has the high rate of recurrence, mortality, regional nodal involvement, and distant metastases. It is difficult to diagnose MCC because of its non-specific clinical findings. It usually occurs on sun-exposed areas of the skin, mostly at head and neck. There is a difference in the incidence and prognosis according to site in the head and neck. However, there is no consented site-specific diagnosis, treatment or follow-up protocol for MCC at the head and neck. We herein report a case of MCC arising in the right earlobe of an otherwise healthy young man who has been diagnosed early, thereby successfully treated. With our closed follow-up, there was no tumor recurrence or complication at 33 months after diagnosis.
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Affiliation(s)
- Non Hyeon Ha
- Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Suwon, Korea
| | - Sue Kyung Kim
- Department of Dermatology, Seoul Medical Center, Seoul, Korea
| | - Yoo Seob Shin
- Department of Otolaryngology, Ajou University Hospital, Suwon, Korea
| | - Sue Min Kim
- Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Suwon, Korea
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16
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Taralli S, Sollini M, Milella M, Perotti G, Filice A, Menga M, Versari A, Rufini V. 18F-FDG and 68Ga-somatostatin analogs PET/CT in patients with Merkel cell carcinoma: a comparison study. EJNMMI Res 2018; 8:64. [PMID: 30032450 PMCID: PMC6054830 DOI: 10.1186/s13550-018-0423-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 07/06/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is an aggressive neuroendocrine skin tumor. Currently, 18F-fluoro-deoxy-glucose (18F-FDG) PET/CT is the functional imaging modality of choice. Few data are available on the use of 68Ga-somatostatin analogs. The aim of our study was to evaluate and compare the diagnostic performance of 18F-FDG and 68Ga-somatostatin analog PET/CT in MCC patients. RESULTS Fifteen patients (12 males, 3 females; median age 73 years; range 41-81 years) with histologically proven MCC (4 with unknown primary lesion) who underwent both 18F-FDG and 68Ga-somatostatin analog PET/CT for staging, re-staging, or treatment response assessment were retrospectively evaluated. Results of both studies were qualitatively analyzed and compared on a patient- and lesion-based analysis, using histology or clinical/radiological follow-up as reference standard for final diagnosis. According to final diagnosis, 8/15 patients had at least one MCC lesion and 7/15 had no evidence of disease. On a patient-based analysis, 18F-FDG and 68Ga-somatostatin analogs correctly classified as positive 8/8 (100% sensitivity) patients and as negative 6/7 (85.7% specificity) and 5/7 (71.4% specificity) patients, respectively, with no significant difference. On a lesion-based analysis, 18F-FDG detected 67/75 lesions (89%) and 68Ga-somatostatin analogs 69/75 (92%), with no significant difference. In four patients with unknown primary MCC, both tracers failed to identify the primary MCC site. CONCLUSIONS Our preliminary data suggest that 18F-FDG and 68Ga-somatostatin analog PET/CT provide good and equivalent diagnostic performance, adding interesting insights into the complex MCC biology. However, these results do not suggest that 18F-FDG PET/CT should be replaced by 68Ga-somatostatin receptor imaging, which should be performed in addition, according to clinical indication, to the perspective of "personalized medicine."
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Affiliation(s)
- Silvia Taralli
- Department of Diagnostic Imaging, Radiation Oncology and Hematology, Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Martina Sollini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy
| | - Michele Milella
- Division of Medical Oncology, Regina Elena National Cancer Institute, Rome, Italy
| | - Germano Perotti
- Department of Diagnostic Imaging, Radiation Oncology and Hematology, Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Angelina Filice
- Nuclear Medicine Unit, Arcispedale Santa Maria Nuova—IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Menga
- Nuclear Medicine Unit, Arcispedale Santa Maria Nuova—IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Annibale Versari
- Nuclear Medicine Unit, Arcispedale Santa Maria Nuova—IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Vittoria Rufini
- Department of Diagnostic Imaging, Radiation Oncology and Hematology, Institute of Nuclear Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma—Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Roma, Italia
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17
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Mendenhall WM, Morris CG, Kirwan JM, Amdur RJ, Shaw C, Dziegielewski PT. Management of cutaneous Merkel cell carcinoma. Acta Oncol 2018; 57:320-323. [PMID: 28712323 DOI: 10.1080/0284186x.2017.1349926] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE To report the outcomes of patients with previously untreated cutaneous Merkel cell carcinoma (MCC) managed with curative intent. MATERIAL AND METHODS Between December 1984 and August 2015, 59 patients with previously untreated cutaneous MCC were managed with curative intent with surgery and adjuvant radiotherapy (54 patients) or radiotherapy alone (5 patients) at the University of Florida. Primary sites included head and neck (45 patients), extremities (11 patients) and trunk (3 patients). Adjuvant chemotherapy was employed in 14 patients. Patients were staged according to the AJCC staging system: stage I, 25 patients; stage IIA, 7 patients; and, stage III, 27 patients. No patients had distant metastases. Median follow-up for all patients was 3.2 years (range, 0.3-20.9 years). Median follow-up for survivors was 6.7 years (range, 1.6-20.9 years). RESULTS The 5-year outcomes were as follows: local control, 91%; regional control, 79%; local-regional control, 77%; disease metastasis-free survival, 60%; cause-specific survival, 53%; and overall survival, 39%. The 5-year outcomes for patients with stage I-IIA versus stage-III disease were the following: local-regional control, 90% versus 57% (p = .0115); distant metastasis-free survival, 78% versus 36% (p = .0002); cause-specific survival, 68% versus 35% (p = .0050); and overall survival, 48% versus 27% (p = .0377). Local-regional recurrences occurred in 12 patients; no patients were successfully salvaged. Severe late complications were observed in four patients. CONCLUSIONS Although radiotherapy alone or combined with surgery results in a relatively high likelihood of local-regional control, the majority of recurrences are distant and approximately half of patients are cured. Patients with regional disease at diagnosis have significantly worse outcomes.
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Affiliation(s)
- William M. Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Christopher G. Morris
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Jessica M. Kirwan
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Robert J. Amdur
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Christiana Shaw
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Peter T. Dziegielewski
- Department of Otolaryngology, University of Florida College of Medicine, Gainesville, FL, USA
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18
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Abstract
Merkel cell carcinoma (MCC) is a rare but highly aggressive skin cancer with neuroendocrine features. MCC pathogenesis is associated with either the presence of Merkel cell polyomavirus or chronic exposure to ultraviolet light (UV), which can cause a characteristic pattern of multiple DNA mutations. Notably, in the Northern hemisphere, the majority of MCC cases are of viral aetiology; by contrast, in areas with high UV exposure, UV-mediated carcinogenesis is predominant. The two aetiologies share similar clinical, histopathological and prognostic characteristics. MCC presents with a solitary cutaneous or subcutaneous nodule, most frequently in sun-exposed areas. In fact, UV exposure is probably involved in both viral-mediated and non-viral-mediated carcinogenesis, by contributing to immunosuppression or DNA damage, respectively. Confirmation of diagnosis relies on analyses of histological features and immunological marker expression profiles of the lesion. At primary diagnosis, loco-regional metastases are already present in ∼30% of patients. Excision of the tumour is the first-line therapy; if not feasible, radiotherapy can often effectively control the disease. Chemotherapy was the only alternative in advanced-stage or refractory MCC until several clinical trials demonstrated the efficacy of immune-checkpoint inhibitors.
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