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Vayntraub A, Tayeb N, Squires B, Mehnert JM, Hassan Ii Q, Sebastian NT, Deryaniyagala R, Quinn TJ. The Association of Radiation Therapy and Chemotherapy on Overall Survival in Merkel Cell Carcinoma: A Population-Based Analysis. Cureus 2021; 13:e18276. [PMID: 34722054 PMCID: PMC8545516 DOI: 10.7759/cureus.18276] [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: 09/25/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose/objective(s) Merkel cell carcinoma (MCC) is a rare, aggressive cutaneous neoplasm traditionally managed with surgical resection followed by radiotherapy (RT). With the recent approval of checkpoint inhibitors, chemotherapy is less commonly utilized. We analyzed the impact of RT and chemotherapy on overall survival (OS) in patients with MCC using Surveillance, Epidemiology, and End Results (SEER), a population-level database. Materials and methods We performed retrospective analyses on SEER 18 Custom Data registries for MCC (ICD-0-3 8247). Data from 1980 to 2016 was queried for analysis, and an initial list of 9,792 patients was populated (ICD: C00, C07.9, C44, C80.9). Selection for cases with chemotherapy and RT status, single primary tumor, primary tumor location and surgery treatment type yielded 5,002 cases for analysis. Baseline characteristics were compared with Chi-square or Mann-Whitney U test. Univariate and multivariable analysis using Kaplan-Meier and Cox proportional hazards regression modeling were performed. Propensity-score matched analysis with inverse probability of treatment weighting (IPTW) was used to account for indication bias. Results Median follow-up time was 178 months (68 to 217 months). Independent prognostic factors positively correlated with increased OS, for both unadjusted Multivariate analysis and IPTW adjusted MVA were age, male sex, year of diagnosis, stage, RT status, and chemotherapy status. On adjusted MVA, use of chemotherapy was associated with worse OS (hazard ratio: 1.22 [95% CI 1.1-1.35], p<0.001), whereas RT was associated with improved OS (HR:0.9 [95% CI, 0.83-0.97], p=0.008). Conclusions The current study demonstrates that RT is associated with improved survival for patients with MCC. Chemotherapy was associated with worse OS. This supports the recent clinical shift towards immune checkpoints inhibitors as standard of care in the metastatic setting, and promising trials in the adjuvant and advanced settings.
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Affiliation(s)
| | - Nadine Tayeb
- Department of Radiation Oncology, Michigan State University College of Human Medicine, East Lansing, USA
| | - Bryan Squires
- Department of Radiation Oncology, Beaumont Health, Royal Oak, USA
| | - Janice M Mehnert
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, USA
| | - Quais Hassan Ii
- Medical Scientist Training Program, The Ohio State University College of Medicine, Columbus, USA
| | - Nikhil T Sebastian
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, USA
| | | | - Thomas J Quinn
- Department of Radiation Oncology, Beaumont Health, Royal Oak, USA
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Yin X, She H, Martin Kasyanju Carrero L, Ma W, Zhou B. Nomogram prediction for the overall survival and cancer-specific survival of patients diagnosed with Merkel cell carcinoma. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:286. [PMID: 33708913 PMCID: PMC7944317 DOI: 10.21037/atm-20-4578] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine carcinoma of the skin, with a high recurrence rate and a high mortality rate worldwide. The purpose of this article is to construct a nomogram that incorporates significant clinical parameters and predicts the survival of individuals with MCC. Methods The Surveillance, Epidemiology, and End Results (SEER) database was employed to retrospectively analyze all confirmed MCC cases from 2004 to 2015. The data was collected from 3,688 patients, and was randomized as the training or validation group (1:1 ratio). The independent factors which predicted the cancer-specific survival (CSS) and overall survival (OS) for MCC cases were searched for nomogram construction respectively. Independent parameters that affected CSS were determined using the Fine and Gray competing risk regression model. In addition, the time-dependent receiver operating characteristic (ROC) curve was constructed. Then, the area under the curve (AUC) values, calibration curve, and the concordance index (C-index) were used to determine the nomogram performance. At last, decision curve analysis (DCA) was conducted to determine the net clinical benefit. Results The multivariate analysis results revealed that sex, age, race, marriage, American Joint Committee on Cancer (AJCC) stage, chemotherapy and radiotherapy were independent OS prognostic factors. Furthermore, competing risk analysis showed age, sex, AJCC stage, chemotherapy were the independent CSS prognostic factors. For validation, the C-index value of OS nomogram was 0.703 (95% CI: 0.686-0.721), while C-index value of CSS nomogram was 0.737 (95% CI: 0.710-0.764). Both C-index and AUC suggested that nomograms had superior performance to that of the AJCC stage system. In addition, according to the calibration curve, both nomograms were capable of accurate prediction of MCC prognosis. The DCA showed that the net benefits of the nomograms were superior among various threshold probabilities than these of AJCC stage system. Conclusions The present work established and verified the novel nomograms to predict the OS and CSS of MCC patients. If further confirmed in future studies, it may become another helpful tool for risk stratification and management of MCC patients.
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Affiliation(s)
- Xufeng Yin
- Department of Dermatology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Huihui She
- Department of Dermatology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | | | - Weiwei Ma
- Department of Dermatology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Bingrong Zhou
- Department of Dermatology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Steven N, Lawton P, Poulsen M. Merkel Cell Carcinoma - Current Controversies and Future Directions. Clin Oncol (R Coll Radiol) 2020; 31:789-796. [PMID: 31594644 DOI: 10.1016/j.clon.2019.08.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/19/2019] [Accepted: 08/28/2019] [Indexed: 12/12/2022]
Abstract
Merkel cell carcinoma is a rare, aggressive neuroendocrine skin malignancy. Evidence for management comes from case series and single-arm trials. Optimal outcomes require assessment of the patient in a multidisciplinary team setting. Rapid diagnosis and staging are essential for locoregional control and may reduce metastasis. Sentinel lymph node biopsy (SLNB) adds prognostic information. FDG-positron emission tomography has high sensitivity and specificity and affects management in a quarter of cases. Surgical excision and radiotherapy provide good locoregional control even with positive margins. Wide surgical margins are needed if adjuvant radiotherapy is not used. It is uncertain whether adjuvant radiotherapy or elective surgery for uninvolved nodes or for patients selected by positive SLNB improves survival. Total doses of 50 Gy provide high levels of control for microscopic disease but at least 60 Gy should be given for macroscopic disease. Chemotherapy can be given safely with radiotherapy, but the benefit of adjuvant chemotherapy remains uncertain. Trials of adjuvant immune therapy are underway. Unresectable primaries might be controlled with radiotherapy alone or combination systemic therapy, radiotherapy and surgery. Metastatic disease often responds to chemotherapy, but the response duration can be short. Immunity is central to disease control. Immune checkpoint inhibitor treatment resulted in high response rates in chemotherapy-naive patients and lower rates in chemotherapy-refractory patients. Durable responses are observed.
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Affiliation(s)
- N Steven
- University of Birmingham, Birmingham, UK.
| | - P Lawton
- University of Nottingham, Nottingham, UK
| | - M Poulsen
- The University of Queensland, Brisbane, Queensland, Australia
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4
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Laikova KV, Oberemok VV, Krasnodubets AM, Gal'chinsky NV, Useinov RZ, Novikov IA, Temirova ZZ, Gorlov MV, Shved NA, Kumeiko VV, Makalish TP, Bessalova EY, Fomochkina II, Esin AS, Volkov ME, Kubyshkin AV. Advances in the Understanding of Skin Cancer: Ultraviolet Radiation, Mutations, and Antisense Oligonucleotides as Anticancer Drugs. Molecules 2019; 24:E1516. [PMID: 30999681 PMCID: PMC6514765 DOI: 10.3390/molecules24081516] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/13/2019] [Accepted: 04/15/2019] [Indexed: 12/15/2022] Open
Abstract
Skin cancer has always been and remains the leader among all tumors in terms of occurrence. One of the main factors responsible for skin cancer, natural and artificial UV radiation, causes the mutations that transform healthy cells into cancer cells. These mutations inactivate apoptosis, an event required to avoid the malignant transformation of healthy cells. Among these deadliest of cancers, melanoma and its 'younger sister', Merkel cell carcinoma, are the most lethal. The heavy toll of skin cancers stems from their rapid progression and the fact that they metastasize easily. Added to this is the difficulty in determining reliable margins when excising tumors and the lack of effective chemotherapy. Possibly the biggest problem posed by skin cancer is reliably detecting the extent to which cancer cells have spread throughout the body. The initial tumor is visible and can be removed, whereas metastases are invisible to the naked eye and much harder to eliminate. In our opinion, antisense oligonucleotides, which can be used in the form of targeted ointments, provide real hope as a treatment that will eliminate cancer cells near the tumor focus both before and after surgery.
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Affiliation(s)
- Kateryna V Laikova
- Medical Academy named after S.I. Georgievsky, V.I. Vernadsky Crimean Federal University, Lenin Boulevard 5/7, 295051 Simferopol, Crimea.
- Research Institute of Agriculture of Crimea, Kiyevskaya St. 150, 295493, Simferopol, Crimea.
| | - Volodymyr V Oberemok
- Taurida Academy, V.I. Vernadsky Crimean Federal University, Vernadsky Av. 4, 295007 Simferopol, Crimea.
- Nikita Botanical Gardens ⁻ National Scientific Centre RAS, Nikitsky spusk 52, vil. Nikita, 298648 Yalta, Crimea.
| | - Alisa M Krasnodubets
- Taurida Academy, V.I. Vernadsky Crimean Federal University, Vernadsky Av. 4, 295007 Simferopol, Crimea.
| | - Nikita V Gal'chinsky
- Taurida Academy, V.I. Vernadsky Crimean Federal University, Vernadsky Av. 4, 295007 Simferopol, Crimea.
| | - Refat Z Useinov
- Taurida Academy, V.I. Vernadsky Crimean Federal University, Vernadsky Av. 4, 295007 Simferopol, Crimea.
| | - Ilya A Novikov
- Taurida Academy, V.I. Vernadsky Crimean Federal University, Vernadsky Av. 4, 295007 Simferopol, Crimea.
| | - Zenure Z Temirova
- Medical Academy named after S.I. Georgievsky, V.I. Vernadsky Crimean Federal University, Lenin Boulevard 5/7, 295051 Simferopol, Crimea.
| | - Mikhail V Gorlov
- D. Mendeleev University of Chemical Technology of Russia, Miusskaya sq. 9, 125047 Moscow, Russia.
| | - Nikita A Shved
- Centre for Genomic and Regenerative Medicine, School of Biomedicine, Far Eastern Federal University, Sukhanova St. 8, 690090 Vladivostok, Russia.
- National Scientific Center of Marine Biology, Far Eastern Branch of Russian Academy of Sciences, Palchevsky St. 17, 690041 Vladivostok, Russia.
| | - Vadim V Kumeiko
- Centre for Genomic and Regenerative Medicine, School of Biomedicine, Far Eastern Federal University, Sukhanova St. 8, 690090 Vladivostok, Russia.
- National Scientific Center of Marine Biology, Far Eastern Branch of Russian Academy of Sciences, Palchevsky St. 17, 690041 Vladivostok, Russia.
| | - Tatiana P Makalish
- Medical Academy named after S.I. Georgievsky, V.I. Vernadsky Crimean Federal University, Lenin Boulevard 5/7, 295051 Simferopol, Crimea.
| | - Evgeniya Y Bessalova
- Medical Academy named after S.I. Georgievsky, V.I. Vernadsky Crimean Federal University, Lenin Boulevard 5/7, 295051 Simferopol, Crimea.
| | - Iryna I Fomochkina
- Medical Academy named after S.I. Georgievsky, V.I. Vernadsky Crimean Federal University, Lenin Boulevard 5/7, 295051 Simferopol, Crimea.
| | - Andrey S Esin
- D. Mendeleev University of Chemical Technology of Russia, Miusskaya sq. 9, 125047 Moscow, Russia.
| | - Mikhail E Volkov
- Ltd "NPF Syntol", Тimiryazevskaya St. 42, 127434 Moscow, Russia.
| | - Anatoly V Kubyshkin
- Medical Academy named after S.I. Georgievsky, V.I. Vernadsky Crimean Federal University, Lenin Boulevard 5/7, 295051 Simferopol, Crimea.
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Veija T, Kero M, Koljonen V, Böhling T. ALK and EGFR expression by immunohistochemistry are associated with Merkel cell polyomavirus status in Merkel cell carcinoma. Histopathology 2019; 74:829-835. [PMID: 30588655 DOI: 10.1111/his.13815] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 12/24/2018] [Indexed: 12/18/2022]
Abstract
AIMS Merkel cell carcinoma, a rare cutaneous neuroendocrine tumour of the skin, can be categorised into two groups according to Merkel cell polyomavirus (MCV) presence. MCV-negative tumours are more aggressive and frequently associated with gene mutations. Some of the genes are potential therapeutic targets. We have previously reported EGFR mutations in six of 27 MCC tumours and overexpression of ALK and EZH2 at mRNA level in MCC tumours. In this study, we sought to determine expression of ALK, EGFR and EZH2 in MCC samples and assess their correlation to MCV status and clinical parameters. METHODS AND RESULTS Tissue microarrays were utilised and stained with primary antibodies. Staining data were statistically compared to patient sex, tumour location and development of metastasis and MCC-specific death; 112 tumours and their corresponding patient data were included. We found strong expression of ALK in 51% and strong expression of EZH2 in 76% of the tumours. There was evident correlation of ALK expression with MCV-positivity. Expression of EGFR was infrequent, presenting only in seven MCV-negative tumours. None of the proteins associated with development of metastasis or MCC specific death. CONCLUSIONS ALK and EZH2 expression are frequent in MCC and ALK expression correlates to MCV positivity. EGFR positive tumours might respond to EGFR inhibiting treatment.
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Affiliation(s)
- Tuukka Veija
- Department of Pathology, University of Helsinki, Helsinki, Finland
| | - Mia Kero
- Department of Pathology, University of Helsinki and HUSLAB, Helsinki University Hospital, Helsinki, Finland
| | - Virve Koljonen
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tom Böhling
- Department of Pathology, University of Helsinki, Helsinki, Finland
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6
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Giroulet F, Tabotta F, Pomoni A, Prior J. Primary parotid Merkel cell carcinoma: a first imagery and treatment response assessment by 18F-FDG PET. BMJ Case Rep 2019; 12:12/3/e226511. [PMID: 30852509 PMCID: PMC6424177 DOI: 10.1136/bcr-2018-226511] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Fabrice Giroulet
- Médecine Nucléaire et Imagerie Moléculaire, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Flavian Tabotta
- Médecine Nucléaire et Imagerie Moléculaire, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Anastasia Pomoni
- Médecine Nucléaire et Imagerie Moléculaire, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - John Prior
- Médecine Nucléaire et Imagerie Moléculaire, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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7
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Gallo M, Guarnotta V, De Cicco F, Rubino M, Faggiano A, Colao A. Immune checkpoint blockade for Merkel cell carcinoma: actual findings and unanswered questions. J Cancer Res Clin Oncol 2019; 145:429-443. [PMID: 30617553 DOI: 10.1007/s00432-019-02839-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 01/02/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine carcinoma arising from the skin. We aimed to review and deal with some of the most relevant controversial topics on the correct use of immunotherapy for the treatment of MCC. METHODS The primary search was carried out via PubMed, EMBASE, and the Cochrane Library (until 31st May, 2018), while other articles and guidelines were retrieved from related papers or those referenced in these papers. Additionally, we performed an extensive search on ClinicalTrials.gov to gather information on the ongoing clinical trials related to this specific topic. RESULTS We performed an up-to-date critical review taking into account the results of both retrospective and prospective published studies evaluating these issues: Are there any predictive criteria of response to immunotherapy? What is the correct place of immunotherapy in the treatment algorithm of MCC? What is the best choice after immunotherapy failure? What to do with patients for whom immunotherapy is not been feasible or contraindicated? How long should immunotherapy be prolonged, and what follow-up should be offered after complete response? CONCLUSION The therapeutic landscape of MCC is rapidly evolving: many open issues will probably be resolved, and many other questions are likely to arise in the next few years. The results of ongoing prospective clinical trials and of several other studies on these issues are eagerly awaited.
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Affiliation(s)
- Marco Gallo
- Oncological Endocrinology Unit, Department of Medical Sciences, University of Turin, AOU Città della Salute e della Scienza di Torino, Via Genova 3, 10126, Turin, Italy.
| | - Valentina Guarnotta
- Section of Endocrine-Metabolic Diseases, Biomedical Department of Internal and Specialist Medicine (DIBIMIS), University of Palermo, Palermo, Italy
| | - Federica De Cicco
- Department of Clinical Medicine and Surgery, University "Federico II", Naples, Italy
| | - Manila Rubino
- Unit of Gastrointestinal Medical Oncology and Neuroendocrine Tumours, European Institute of Oncology, IEO, Milan, Italy
| | - Antongiulio Faggiano
- Department of Clinical Medicine and Surgery, University "Federico II", Naples, Italy
| | - Annamaria Colao
- Department of Clinical Medicine and Surgery, University "Federico II", Naples, Italy
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8
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Chernock RD, Duncavage EJ. Proceedings of the NASHNP Companion Meeting, March 18th, 2018, Vancouver, BC, Canada: Salivary Neuroendocrine Carcinoma-An Overview of a Rare Disease with an Emphasis on Determining Tumor Origin. Head Neck Pathol 2018; 12:13-21. [PMID: 29556963 PMCID: PMC5873497 DOI: 10.1007/s12105-018-0896-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 11/20/2017] [Indexed: 12/16/2022]
Abstract
Salivary neuroendocrine carcinomas are rare and the overwhelming majority is high-grade. The parotid gland is the most commonly involved site followed by the submandibular gland. Most arise de novo but rare examples occurring as a high-grade transformation of another type of salivary gland neoplasm exist. There is significant morphologic and immunophenotypic overlap with neuroendocrine carcinomas of other sites, especially the skin. Like cutaneous neuroendocrine (or Merkel cell) carcinomas, approximately three-fourths are cytokeratin 20 positive. Cytokeratin 20 positive salivary neuroendocrine carcinomas are often referred to as being of the 'Merkel cell type' since most other non-cutaneous neuroendocrine carcinomas are cytokeratin 20 negative. Salivary neuroendocrine carcinomas may be challenging to separate from Merkel cell carcinomas of the head and neck on pathologic grounds because the latter often metastasize to the parotid gland. Clinical history is often relied upon to separate primary salivary tumors from cutaneous metastases but may not be helpful in all cases. Here we review the clinical, pathologic and molecular features of salivary neuroendocrine carcinomas focusing on high-grade major salivary gland tumors. The difficulty in separating salivary tumors from metastatic Merkel cell carcinoma will be highlighted.
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Affiliation(s)
- Rebecca D. Chernock
- Department of Pathology and Immunology, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8118, St. Louis, MO USA ,Department of Otolaryngology Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO USA
| | - Eric J. Duncavage
- Department of Pathology and Immunology, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8118, St. Louis, MO USA
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Kitamura S, Yanagi T, Inamura-Takashima Y, Imafuku K, Hata H, Uehara J, Ishida Y, Otsuka A, Hirata K, Shimizu H. Retrospective study on the correlation between 18-fluorodeoxyglucose uptake in positron emission tomography-computer tomography and tumour volume, cytological activity as assessed with Ki-67 and GLUT-1 staining in 10 cases of Merkel cell carcinoma. J Eur Acad Dermatol Venereol 2018; 32:e285-e287. [PMID: 29377285 DOI: 10.1111/jdv.14821] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- S Kitamura
- Department of Dermatology, Hokkaido University Graduate School of Medicine, North 15 West 7, Sapporo, 060-8638, Japan
| | - T Yanagi
- Department of Dermatology, Hokkaido University Graduate School of Medicine, North 15 West 7, Sapporo, 060-8638, Japan
| | - Y Inamura-Takashima
- Department of Dermatology, Hokkaido University Graduate School of Medicine, North 15 West 7, Sapporo, 060-8638, Japan
| | - K Imafuku
- Department of Dermatology, Hokkaido University Graduate School of Medicine, North 15 West 7, Sapporo, 060-8638, Japan
| | - H Hata
- Department of Dermatology, Hokkaido University Graduate School of Medicine, North 15 West 7, Sapporo, 060-8638, Japan
| | - J Uehara
- Department of Dermatology, Asahikawa University Graduate School of Medicine, Midorigaoka-Higashi 2-1-1-1, Asahikawa, 078-8510, Japan
| | - Y Ishida
- Department of Dermatology, Kyoto University Graduate School of Medicine, Shogoin-Kawara, Sakyo, Kyoto, 606-8507, Japan
| | - A Otsuka
- Department of Dermatology, Kyoto University Graduate School of Medicine, Shogoin-Kawara, Sakyo, Kyoto, 606-8507, Japan
| | - K Hirata
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, North 15 West 7, Sapporo, 060-8638, Japan
| | - H Shimizu
- Department of Dermatology, Hokkaido University Graduate School of Medicine, North 15 West 7, Sapporo, 060-8638, Japan
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Abstract
Merkel cell carcinoma (MCC) is a rare and aggressive skin cancer with a neuroendocrine phenotype. Here, the authors reported a case of MCC, presented as a rapidly growing, asymptomatic, erythematous nodule measuring 3.8 cm × 2.8 cm in diameter on the right cheek of an 85-year-old Caucasian woman. After resection of the nodule, the defect was repaired with cutaneous graft taken from the supraclavicular area and healed uneventfully. Histopathologic examination confirmed the diagnosis of MCC.
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Sims JR, Grotz TE, Pockaj BA, Joseph RW, Foote RL, Otley CC, Weaver AL, Jakub JW, Price DL. Sentinel lymph node biopsy in Merkel cell carcinoma: The Mayo Clinic experience of 150 patients. Surg Oncol 2017; 27:11-17. [PMID: 29549898 DOI: 10.1016/j.suronc.2017.10.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 09/14/2017] [Accepted: 10/25/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a rare cutaneous malignancy of neuroendocrine origin with a high propensity for lymph node metastasis. Sentinel lymph node (SLN) status is important for accurate staging; however, the optimal treatment following SLN biopsy, regardless of nodal status, remains unclear. METHODS 150 patients with MCC who underwent SLN biopsy from 1995 to 2011 at 3 Mayo Clinic sites were reviewed. RESULTS Of 150 patients with MCC who underwent SLN biopsy, 39 (26%) were positive and 111 (74%) were negative. There was no significant difference between the sex, age, tumor location, or size of primary in the positive and negative SLN groups. While there was no difference in the cumulative incidence of any regional recurrence between SLN groups, the rate of in-transit recurrences was significantly higher in patients with a positive SLN (p = 0.022). The disease-specific survival for MCC was 97.0%, 82.4%, and 82.4% at 1, 3, and 5 years with a positive SLN and 99.0%, 94.9%, and 86.8% with a negative SLN (p = 0.31). Among those alive at last follow up, the median follow up was 3.8 years (IQR, 2.1-8.4) and 2.9 years (IQR, 1.8-6.1) for positive and negative SLN cohorts respectively. CONCLUSIONS Occult nodal metastasis is common in MCC(26%). No tumor or patient characteristics were identified to predict SLN positivity. Patients with a positive SLN have a higher risk of in-transit recurrence and may benefit from adjuvant radiation with inclusion of the in-transit field in amenable cases. When patients with a positive SLN receive additional treatment to the at-risk nodal basin, both OS and DSS are similar to patients with a negative SLN.
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Affiliation(s)
- John R Sims
- Department of Otorhinolaryngology, Mayo Clinic Rochester, MN, USA
| | | | | | - Richard W Joseph
- Department of Medical Oncology, Mayo Clinic Jacksonville, FL, USA
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic Rochester, MN, USA
| | - Clark C Otley
- Department of Dermatology, Mayo Clinic Rochester, MN, USA
| | - Amy L Weaver
- Department of Health Sciences Research, Mayo Clinic Rochester, MN, USA
| | - James W Jakub
- Department of Surgery, Mayo Clinic Rochester, MN, USA
| | - Daniel L Price
- Department of Otorhinolaryngology, Mayo Clinic Rochester, MN, USA.
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12
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Kadiri S, Aissa A, Berhili S, Khmou M, Elmajjaoui S, Kebdani T, El Khannoussi B, Elkacemi H, Benjaafar N. Merkel cell carcinoma occurring in a black woman: a case report. J Med Case Rep 2017; 11:25. [PMID: 28143624 PMCID: PMC5282901 DOI: 10.1186/s13256-016-1189-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 12/27/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Merkel cell carcinoma is a rare, very aggressive neuroectodermal tumor of the skin. It is typically located on sun-exposed skin and frequently found in white men aged between 70 and 80 years. CASE PRESENTATION We report a case of a 58-year-old black woman diagnosed with Merkel cell carcinoma of the posterior face of the right elbow. She had biopsy excision and was lost to follow-up. Four months later, she presented with recurrent disease on the inferior third of the right arm with three ipsilateral axillary lymph node metastases. Amputation of the right arm and ipsilateral axillary lymph node dissection were performed, followed by adjuvant radiotherapy. Six months later, the patient died as a result of respiratory failure caused by lung metastasis. To the best of our knowledge, no specific studies have been done comparing the course and the characteristics of Merkel cell carcinoma in white and black populations, and no similar case has been reported in the literature. CONCLUSIONS The Merkel cell carcinoma is very rare in black people. As described elsewhere in the literature, our patient had a poor outcome despite radical management. To date, to the best of our knowledge, there has been no comparison of the prognosis of this tumor in white and black populations.
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Affiliation(s)
- Selma Kadiri
- Department of Radiotherapy, National Institute of Oncology, Rabat, Morocco
| | - Abdellah Aissa
- Department of Radiotherapy, National Institute of Oncology, Rabat, Morocco
| | - Soufiane Berhili
- Department of Radiotherapy, National Institute of Oncology, Rabat, Morocco
| | - Mouna Khmou
- Department of Cytopathology, National Institute of Oncology, Rabat, Morocco
| | - Sanaa Elmajjaoui
- Department of Radiotherapy, National Institute of Oncology, Rabat, Morocco
| | - Tayeb Kebdani
- Department of Radiotherapy, National Institute of Oncology, Rabat, Morocco
| | | | - Hanan Elkacemi
- Department of Radiotherapy, National Institute of Oncology, Rabat, Morocco
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McGowan MA, Helm MF, Tarbox MB. Squamous Cell Carcinoma In Situ Overlying Merkel Cell Carcinoma. J Cutan Med Surg 2016; 20:563-566. [DOI: 10.1177/1203475416649161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Merkel cell carcinoma (MCC) is a rare and aggressive cutaneous neoplasm that has exhibited an exponential increase in incidence in the past 3 decades. Combined MCC and cutaneous squamous cell carcinoma (SCC/MCC) is an uncommon variant of MCC that exhibits worse prognosis than pure MCC. Objective: To describe the clinical presentation, dermoscopy, and histology of an unusual subtype of combined SCC/MCC. Methods and Results: A 73-year-old white woman presented with an ulcerated and violaceous 10-mm plaque on her right jawline that had been present for 2 to 3 months. On dermoscopy, the lesion was predominantly milky pink to red with peripheral crusting and large-caliber polymorphous vessels. Histology revealed SCC in situ above and adjacent to MCC. The tumor was excised with clear margins, and sentinel lymph node scintography was negative for nodal involvement.
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Affiliation(s)
| | - Matthew F. Helm
- Texas Tech University Department of Dermatology, Lubbock, TX, USA
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Cohen PR, Tomson BN, Elkin SK, Marchlik E, Carter JL, Kurzrock R. Genomic portfolio of Merkel cell carcinoma as determined by comprehensive genomic profiling: implications for targeted therapeutics. Oncotarget 2016; 7:23454-67. [PMID: 26981779 PMCID: PMC5029639 DOI: 10.18632/oncotarget.8032] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 02/28/2016] [Indexed: 12/22/2022] Open
Abstract
Merkel cell carcinoma is an ultra-rare cutaneous neuroendocrine cancer for which approved treatment options are lacking. To better understand potential actionability, the genomic landscape of Merkel cell cancers was assessed. The molecular aberrations in 17 patients with Merkel cell carcinoma were, on physician request, tested in a Clinical Laboratory Improvement Amendments (CLIA) laboratory (Foundation Medicine, Cambridge, MA) using next-generation sequencing (182 or 236 genes) and analyzed by N-of-One, Inc. (Lexington, MA). There were 30 genes harboring aberrations and 60 distinct molecular alterations identified in this patient population. The most common abnormalities involved the TP53 gene (12/17 [71% of patients]) and the cell cycle pathway (CDKN2A/B, CDKN2C or RB1) (12/17 [71%]). Abnormalities also were observed in the PI3K/AKT/mTOR pathway (AKT2, FBXW7, NF1, PIK3CA, PIK3R1, PTEN or RICTOR) (9/17 [53%]) and DNA repair genes (ATM, BAP1, BRCA1/2, CHEK2, FANCA or MLH1) (5/17 [29%]). Possible cognate targeted therapies, including FDA-approved drugs, could be identified in most of the patients (16/17 [94%]). In summary, Merkel cell carcinomas were characterized by multiple distinct aberrations that were unique in the majority of analyzed cases. Most patients had theoretically actionable alterations. These results provide a framework for investigating tailored combinations of matched therapies in Merkel cell carcinoma patients.
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Affiliation(s)
- Philip R. Cohen
- Department of Dermatology, University of California San Diego, San Diego, CA, USA
| | | | | | | | | | - Razelle Kurzrock
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, University of California San Diego Moores Cancer Center, San Diego, CA, USA
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Abraham KJ, Zhang X, Vidal R, Paré GC, Feilotter HE, Tron VA. Roles for miR-375 in Neuroendocrine Differentiation and Tumor Suppression via Notch Pathway Suppression in Merkel Cell Carcinoma. THE AMERICAN JOURNAL OF PATHOLOGY 2016; 186:1025-35. [PMID: 26877261 DOI: 10.1016/j.ajpath.2015.11.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 10/21/2015] [Accepted: 11/20/2015] [Indexed: 01/07/2023]
Abstract
Dysfunction of key miRNA pathways regulating basic cellular processes is a common driver of many cancers. However, the biological roles and/or clinical applications of such pathways in Merkel cell carcinoma (MCC), a rare but lethal cutaneous neuroendocrine (NE) malignancy, have yet to be determined. Previous work has established that miR-375 is highly expressed in MCC tumors, but its biological role in MCC remains unknown. Herein, we show that elevated miR-375 expression is a specific feature of well-differentiated MCC cell lines that express NE markers. In contrast, miR-375 is strikingly down-regulated in highly aggressive, undifferentiated MCC cell lines. Enforced miR-375 expression in these cells induced NE differentiation, and opposed cancer cell viability, migration, invasion, and survival, pointing to tumor-suppressive roles for miR-375. Mechanistically, miR-375-driven phenotypes were caused by the direct post-transcriptional repression of multiple Notch pathway proteins (Notch2 and RBPJ) linked to cancer and regulation of cell fate. Thus, we detail a novel molecular axis linking tumor-suppressive miR-375 and Notch with NE differentiation and cancer cell behavior in MCC. Our findings identify miR-375 as a putative regulator of NE differentiation, provide insight into the cell of origin of MCC, and suggest that miR-375 silencing may promote aggressive cancer cell behavior through Notch disinhibition.
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Affiliation(s)
- Karan J Abraham
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
| | - Xiao Zhang
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
| | - Ricardo Vidal
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
| | - Geneviève C Paré
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
| | - Harriet E Feilotter
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
| | - Victor A Tron
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada.
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Blumenthal L, VandenBoom T, Melian E, Peterson A, Hutchens KA. Multiple Primary Merkel Cell Carcinomas Presenting as Pruritic, Painful Lower Leg Tumors. Case Rep Dermatol 2015; 7:316-21. [PMID: 26594171 PMCID: PMC4650991 DOI: 10.1159/000441412] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Merkel cell carcinoma (MCC) is a rare and highly aggressive neuroendocrine tumor of the skin which almost exclusively presents as a solitary tumor. It is most often seen on sun-exposed regions, historically almost exclusively on the head and neck, with only rare case reports on the extremities. Although recent studies have shown increased incidence with up to 20% on the extremities, here we present one of these rare emerging presentations, with the addition of a unique treatment option. Our patient is an 80-year-old male with a 3-month history of multiple raised, rapidly enlarging tumors on the right ankle. Two separate biopsies were performed and demonstrated sheets and clusters of small blue cells filling the dermis with scant cytoplasm, dusty chromatin, and nuclear molding. Subsequent immunohistochemical stains confirmed the diagnosis of multiple primary MCC. Despite the characteristic immunohistochemical profile of primary MCC, the possibility of a metastatic neuroendocrine carcinoma from an alternate primary site was entertained, given his unusual clinical presentation. A complete clinical workup including CT scans of the chest, abdomen, and pelvis showed no evidence of disease elsewhere. Instead of amputation, the patient opted for nonsurgical treatment with radiation therapy alone, resulting in a rapid and complete response. This case represents an unusual presentation of primary MCC and demonstrates further evidence that radiation as monotherapy is an effective local treatment option for inoperable MCC.
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Affiliation(s)
- Laura Blumenthal
- Department of Dermatology, Loyola University Medical Center, Maywood, Ill., USA ; Department of Dermatopathology, Loyola University Medical Center, Maywood, Ill., USA
| | - Timothy VandenBoom
- Department of Dermatopathology, Loyola University Medical Center, Maywood, Ill., USA
| | - Edward Melian
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, Ill., USA
| | - Anthony Peterson
- Department of Dermatology, Loyola University Medical Center, Maywood, Ill., USA
| | - Kelli A Hutchens
- Department of Dermatopathology, Loyola University Medical Center, Maywood, Ill., USA
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