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Fennig S, Landman Y, Brenner R, Billan S, Fenig E. Merkel cell carcinoma in lymph nodes with and without primary origin. Cancer Med 2022; 11:1484-1489. [PMID: 35128847 PMCID: PMC8921907 DOI: 10.1002/cam4.4562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Shlomit Fennig
- Institute of Oncology, Edith Wolfson Medical CenterHolonIsrael
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Yosef Landman
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Beilinson HospitalPetah TikvaIsrael
| | - Ronen Brenner
- Institute of Oncology, Edith Wolfson Medical CenterHolonIsrael
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Salem Billan
- Division of OncologyRambam Health Care CampusHaifaIsrael
- Ruth & Bruce Rappaport Faculty of MedicineTechnion – Israel Institute of TechnologyHaifaIsrael
| | - Eyal Fenig
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Beilinson HospitalPetah TikvaIsrael
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2
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Longo R, Balasanu O, Chastenet de Castaing M, Chatelain E, Yacoubi M, Campitiello M, Marcon N, Plastino F. A Spontaneous Regression of an Isolated Lymph Node Metastasis from a Primary Unknown Merkel Cell Carcinoma in a Patient with an Idiopathic Hyper-Eosinophilic Syndrome. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:1437-1440. [PMID: 30510152 PMCID: PMC6287448 DOI: 10.12659/ajcr.911840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Patient: Male, 69 Final Diagnosis: Spontaneous regression of a Lymph node metastasis Symptoms: Hypereosinophilia • inguinal mass Medication: — Clinical Procedure: — Specialty: Oncology
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Affiliation(s)
- Raffaele Longo
- Division of Medical Oncology, Centre Hospitalier Régional (CHR) Metz-Thionville, Ars-Laquenexy, France
| | - Oana Balasanu
- Division of Hematology, Centre Hospitalier Régional (CHR) Metz-Thionville, Ars-Laquenexy, France
| | | | - Eric Chatelain
- Division of Surgery, Centre Hospitalier Régional (CHR) Metz-Thionville, Ars-Laquenexy, France
| | - Mohammed Yacoubi
- Division of Radiotherapy, Centre Hospitalier Régional (CHR) Metz-Thionville, Ars-Laquenexy, France
| | - Marco Campitiello
- Division of Medical Oncology, Centre Hospitalier Régional (CHR) Metz-Thionville, Ars-Laquenexy, France
| | - Nathalie Marcon
- Division of Pathology, Centre Hospitalier Régional (CHR) Metz-Thionville, Ars-Laquenexy, France
| | - Francesca Plastino
- Division of Medical Oncology, Centre Hospitalier Régional (CHR) Metz-Thionville, Ars-Laquenexy, France
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Walsh NM. Complete spontaneous regression of Merkel cell carcinoma (1986-2016): a 30 year perspective. J Cutan Pathol 2016; 43:1150-1154. [PMID: 27596690 DOI: 10.1111/cup.12812] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/16/2016] [Accepted: 08/30/2016] [Indexed: 01/12/2023]
Affiliation(s)
- Noreen M Walsh
- Departments of Pathology and Medicine, Nova Scotia Health Authority and Dalhousie University, Halifax, Nova Scotia, Canada
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4
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Cirillo F. Spontaneous Regression of Primitive Merkel Cell Carcinoma. Rare Tumors 2015; 7:5961. [PMID: 26788270 PMCID: PMC4703916 DOI: 10.4081/rt.2015.5961] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 08/13/2015] [Accepted: 08/14/2015] [Indexed: 11/23/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare, aggressive skin tumor that mainly occurs in the elderly with a generally poor prognosis. Like all skin cancers, its incidence is rising. Despite the poor prognosis, a few reports of spontaneous regression have been published. We describe the case of a 89-year-old male patient who presented two MCC lesions of the scalp. Following biopsy the lesions underwent complete regression with no clinical evidence of residual tumor up to 24 months. The current knowledge of MCC and the other cases of spontaneous regression described in the literature are reviewed.
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Affiliation(s)
- Fernando Cirillo
- Department of Surgery, General Surgery Unit, Rare Hormonal Tumors Group, AO Istituti Ospitalieri , Cremona, Italy
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5
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Ghatalia P, Morgan CJ, Sonpavde G. Meta-analysis of regression of advanced solid tumors in patients receiving placebo or no anti-cancer therapy in prospective trials. Crit Rev Oncol Hematol 2015; 98:122-36. [PMID: 26597016 DOI: 10.1016/j.critrevonc.2015.10.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 10/05/2015] [Accepted: 10/28/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND A meta-analysis of prospective trials systematically investigated regression of advanced solid tumors in patients receiving placebo or no anticancer therapy to inform on spontaneous regressions. PATIENT AND METHODS Arms of randomized controlled trials (RCTs) of metastatic solid tumors receiving placebo or no anti-cancer therapy were used. Statistical analyses were conducted to calculate the overall response rate (ORR) and to detect differentials based on histology, progression at baseline and prior therapies. RESULTS A total of 7676 patients were evaluable from 61 RCTs evaluating 18 solid tumors. The ORR was 1.95% (95% CI: 1.52-2.48%). There was no significant effect of histology (p=0.110), baseline progressive disease (p>0.20) or the line of therapy (p>0.20) on ORR. CONCLUSIONS Spontaneous regressions are seen across all advanced solid tumors. Some malignancies demonstrated higher rates of spontaneous regressions and may be relatively immunotherapy responsive.
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Affiliation(s)
- Pooja Ghatalia
- Department of Internal Medicine, University of Alabama at Birmingham (UAB), AL, United States
| | - Charity J Morgan
- Department of Biostatistics, UAB School of Medicine, United States
| | - Guru Sonpavde
- Department of Internal Medicine, Section of Medical Oncology, UAB Medical Center, United States.
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Pang C, Sharma D, Sankar T. Spontaneous regression of Merkel cell carcinoma: A case report and review of the literature. Int J Surg Case Rep 2014; 7C:104-8. [PMID: 25603307 PMCID: PMC4336382 DOI: 10.1016/j.ijscr.2014.11.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 11/07/2014] [Accepted: 11/08/2014] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Merkel cell carcinoma (MCC) is a rare and highly aggressive primary cutaneous neuroendocrine carcinoma, most often occurring in the elderly. Recurrence is frequent and in 40% of cases regional and distant metastases develop. Despite this, there have been reports of spontaneous regression. We report the first case of MCC with primary complete spontaneous regression of the nose in an 86-year-old woman following an incisional biopsy. PRESENTATION OF CASE An 86-year-old woman presented with a violaceous lump on the left side of the nose measuring 25 × 25 mm. Incisional biopsy of the lesion showed MCC and immunohistochemistry confirmed diagnosis. Following an 8-week period the lesion completely disappeared and histology did not show any residual MCC but immunohistochemistry demonstrated a mixture of T and B cells. DISCUSSION Complete spontaneous regression (CSR) is rare. The literature documents 22 similar cases of CSR of MCC. From this case report and previous literature the most likely reason for regression is a T-cell mediated immune response. CONCLUSION To the best of our knowledge, this is the first described case of MCC with primary CSR of the nose. Exact mechanism of regression remains unclear. Further research is needed in identifying pathway of immune response and possible immunotherapy as a cure.
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Affiliation(s)
- C Pang
- University of Leicester, Medical school, United Kingdom.
| | - D Sharma
- Department of Histopathology, Leicester Royal Infirmary Hospital, United Kingdom.
| | - T Sankar
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Kettering General Hospital, United Kingdom.
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de Andrade Sousa A, Lopes Rena R, Souza Silva G, Marcos Arantes Soares J, Porcaro-Salles JM, Nunes L, Alves Mesquita R, Correia Jham B. Spontaneous remission of a squamous cell carcinoma of the floor of the mouth. J Craniomaxillofac Surg 2014; 42:1536-9. [DOI: 10.1016/j.jcms.2014.04.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 02/27/2014] [Accepted: 04/22/2014] [Indexed: 01/05/2023] Open
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Chen KT, Papavasiliou P, Edwards K, Zhu F, Perlis C, Wu H, Turaka A, Berger A, Farma JM. A better prognosis for Merkel cell carcinoma of unknown primary origin. Am J Surg 2013; 206:752-7. [PMID: 23835211 DOI: 10.1016/j.amjsurg.2013.02.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Revised: 12/03/2012] [Accepted: 02/28/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND There is limited evidence that Merkel cell carcinoma (MCC) arising from a nodal basin without evidence of a primary cutaneous (PC) site has better prognosis. We present our experience at 2 tertiary care referral centers with stage III MCC with and without a PC site. METHODS Fifty stage III MCC patients were identified between 1996 and 2011. Clinical data were analyzed, with primary endpoints being disease-free survival and overall survival. RESULTS Of stage III patients, 34 patients presented with a PC site and 16 patients with an unknown primary (UP) site. Treatment strategies varied; of patients with UP vs. PC sites, 25% vs. 44% underwent combined regional lymphadenectomy and radiation, with an additional 25% vs. 15% receiving chemotherapy. The median disease-free survival for a UP site was not reached vs. 15 months for a PC site (hazards ratio = .48, P = .18). The median overall survival for a UP site was not reached vs 21 months for a PC site (hazards ratio = .34, P = .03). Multivariate analysis showed that UP status was a significant factor in overall survival (P = .002). CONCLUSIONS Stage III MCC with a UP site portends a better prognosis than MCC with a PC site.
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Affiliation(s)
- Kathryn T Chen
- Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA.
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Anzalone CL, Cohen PR, Migden MR, Tannir NM. Mohs surgery in metastatic cancer: renal cell carcinoma solitary cutaneous metastasis and visceral tumor metastases to skin treated with microscopically controlled surgical excision. Int J Dermatol 2013; 52:856-61. [PMID: 23675612 DOI: 10.1111/ijd.12021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Mohs micrographic surgery is the reference standard treatment for primary cutaneous malignancies. OBJECTIVES The purpose of this case study is to demonstrate that Mohs surgery may be considered as a possible treatment for a solitary metastatic tumor under the appropriate circumstances. METHODS We report a patient in whom a solitary cutaneous metastasis of renal cell carcinoma (RCC) was successfully treated with microscopically controlled surgical excision, and cite instances of the successful management of cutaneous metastases using the Mohs surgical technique in oncology patients reported in the literature. Patient reports and previous reviews of the subject were critically assessed. Salient features are presented. RESULTS Metastases to the skin are rare in RCC. Albeit rarely, surgical excision, particularly Mohs micrographic surgery, has been used for the removal of isolated RCC cutaneous metastases. In the present patient with metastatic RCC, a solitary cutaneous metastasis on the occipital scalp was successfully treated with Mohs micrographic surgery. There was no recurrence of the lesion after two years of follow-up; however, the patient eventually succumbed to progressive disease. CONCLUSIONS We suggest that, in the appropriate setting, surgical excision of isolated cutaneous metastases using microscopically controlled margins at the time of surgery should be added to the indications for Mohs surgery.
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Du-Thanh A, Guillot B. Polyomavirus et tumeur de Merkel. ONCOLOGIE 2013. [DOI: 10.1007/s10269-013-2257-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Foote M, Veness M, Zarate D, Poulsen M. Merkel cell carcinoma: the prognostic implications of an occult primary in stage IIIB (nodal) disease. J Am Acad Dermatol 2011; 67:395-9. [PMID: 22030017 DOI: 10.1016/j.jaad.2011.09.009] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 08/18/2011] [Accepted: 09/08/2011] [Indexed: 11/15/2022]
Abstract
BACKGROUND Merkel cell carcinoma is a highly aggressive cutaneous malignancy with a high rate of lymph node and distant metastatic disease. Approximately one third of patients present with stage IIIB (nodal) disease. OBJECTIVE This cohort study was performed to analyze the outcome of patients with stage IIIB disease with or without an occult primary. METHODS The details of 91 patients with stage IIIB (nodal) Merkel cell carcinoma treated curatively between 1985 and 2010 at 3 tertiary referral hospitals in Australia were reviewed. Kaplan-Meier plots were used with the primary end point being overall survival. Secondary end points were disease-free survival and relapse-free survival. A multivariate Cox regression analysis was performed for known prognostic factors. RESULTS Of 91 patients with stage IIIB (nodal) disease, 36 (40%) had an occult primary. A total of 78 patients (86%) had surgery and 79 patients (87%) had definitive or adjuvant radiotherapy. With a median follow-up of 4.3 years, those with an occult primary did significantly better in terms of overall survival, disease-free survival, and relapse-free survival. On multivariate analysis, occult primary and patient age were the only factors predicting survival with hazard ratios of 0.30 (95% confidence interval 0.13-0.67) and 1.64 (95% confidence interval 1.13-2.38), respectively. LIMITATIONS This is a retrospective study over several decades with patients treated using various modalities. CONCLUSION This study indicates that for patients with stage IIIB (nodal) Merkel cell carcinoma, the presence of an occult primary confers a significantly better prognosis that may have implications in the future staging and treatment of patients with stage III disease.
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Affiliation(s)
- Matthew Foote
- Division of Cancer Services, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia.
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Complete Spontaneous Regression of Metastatic Merkel Cell Carcinoma: A Case Report and Review of the Literature. Am J Dermatopathol 2010; 32:614-7. [DOI: 10.1097/dad.0b013e3181cd3158] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Ciudad C, Avilés JA, Alfageme F, Lecona M, Suárez R, Lázaro P. Spontaneous Regression in Merkel Cell Carcinoma. Dermatol Surg 2010; 36:687-93. [DOI: 10.1111/j.1524-4725.2010.01531.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kim EJ, Kim HS, Kim HO, Jung CK, Ko YH, Kim TH, Park YM. Merkel cell carcinoma of the inguinal lymph node with an unknown primary site. J Dermatol 2009; 36:170-3. [PMID: 19335694 DOI: 10.1111/j.1346-8138.2009.00615.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Merkel cell carcinoma (MCC) is an uncommon and aggressive primary neuroendocrine malignancy of the skin. Frequent local recurrences and disseminations to regional lymph nodes and distant organs are characteristic. MCC within the lymph nodes in the absence of a primary site is rare and has only been reported sporadically. We report a case of MCC presenting as a painless mass in the left inguinal area for 5 months in a 57-year-old man. The histopathology of the excised lesion revealed a poorly differentiated basophilic small cell tumor. The tumor cells were positive for cytokeratin 20 and CD56, negative for cytokeratin 7, thyroid transcription factor-1 and CDX-2. These immunohistochemical findings were consistent with the diagnosis of a metastatic MCC. Despite extensive clinical and radiological investigation, we failed to identify the origin of the tumor. Our case may represent a lymph node metastasis from an occult or regressed skin primary, but we cannot preclude the possibility of a primary nodal tumor.
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Affiliation(s)
- Eun Jung Kim
- Department of Dermatology, Kangnam St Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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Turk T, Orlic ZC, Smoljan I, Nacinovic A, Bekafigo IS, Radic J, Zamolo G. Spontaneous regression of Merkel cell carcinoma in a patient with chronic lymphocytic leukemia: a case report. J Med Case Rep 2009; 3:7270. [PMID: 19830161 PMCID: PMC2726515 DOI: 10.1186/1752-1947-3-7270] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Accepted: 01/22/2009] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Merkel cell carcinoma is a rare and aggressive primary cutaneous neuroendocrine malignant tumor. The tumor has a high rate of local recurrence after surgical removal. Spontaneous regression appears to be relatively common in this rare type of tumor. CASE PRESENTATION We describe the clinical course, cytological and histological findings of a Merkel cell carcinoma in a 70-year-old Caucasian woman, simultaneously diagnosed with chronic lymphatic leukemia. The tumor showed clinical regression after fine needle aspiration. At primary presentation, the tumor had no apparent leukocyte infiltration, but was completely cleared by T-cell mediated immunity within 3 weeks after fine needle aspiration. CONCLUSION Fine needle aspiration may have acted as a mechanical trigger involved in the activation of cell-mediated immunity, leading to the clinical and histological regression of the tumor. To the best of our knowledge, this is the first case report of spontaneous regression of Merkel cell carcinoma in a patient with a co-malignancy, that is to say, chronic lymphocytic leukemia.
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Holak N, Holak H. Merkel Cell Carcinoma. Ophthalmology 2008; 115:1643; author reply 1643. [DOI: 10.1016/j.ophtha.2008.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Accepted: 04/10/2008] [Indexed: 11/16/2022] Open
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Vazmitel M, Michal M, Kempf W, Mukensnabl P, Kazakov DV. Merkel Cell Carcinoma With a Follicular Lymphocytic Infiltrate: Report of 2 Cases. Am J Dermatopathol 2008; 30:389-91. [DOI: 10.1097/dad.0b013e318178336c] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Total Spontaneous Regression of Advanced Merkel Cell Carcinoma after Biopsy. Dermatol Surg 2008. [DOI: 10.1097/00042728-200806000-00018] [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]
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Richetta AG, Mancini M, Torroni A, Lorè B, Iannetti G, Sardella B, Calvieri S. Total spontaneous regression of advanced merkel cell carcinoma after biopsy: review and a new case. Dermatol Surg 2008; 34:815-22. [PMID: 18363731 DOI: 10.1111/j.1524-4725.2008.34153.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Grabowski J, Saltzstein SL, Sadler GR, Tahir Z, Blair S. A comparison of merkel cell carcinoma and melanoma: results from the california cancer registry. Clin Med Oncol 2008; 2:327-33. [PMID: 21892294 PMCID: PMC3161663 DOI: 10.4137/cmo.s423] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Melanoma and Merkel cell carcinoma (MCC) are both aggressive skin malignancies associated with immunosuppression and possible UV exposure. Both tumors get similar surgical treatment; however, MCC is a relatively rare tumor in which less is known about prognosis and clinical behavior. METHODS The California Cancer Registry (CCR), a population-based registry, was reviewed from the years 1988-2003. Merkel cell carcinoma and melanoma were compared with relation to gender, age, ethnicity, disease stage, site, and survival. RESULTS A total of 113,187 cases of melanoma and 1,878 cases of MCC were identified in the CCR. Though both cancers are more common in men than in women, MCC had a higher incidence in men than melanoma (63% vs 57% p < 0.005). MCC occurs in the more elderly, with 73.6% of cases occurring in people over 70 years. In contrast, 69% of melanoma cases occurred in people younger than 70 years (p < 0.005). MCC shows a predilection for the head and neck compared to melanoma (47% vs 25.8%) Additionally, melanoma occurs more frequently on the trunk than MCC (30% vs 8.7%). Finally, the 10-year cumulative survival is lower for MCC than for melanoma (17.7% vs 61.3%, p < 0.005). CONCLUSION Many clinicians assume MCC and melanoma behave similarly. However, MCC occurs in an older population, more frequently on the head and neck, in a higher percentage of men. Additionally, MCC has a higher rate of regional metastasis and thus may have more of a benefit from regional staging procedures. Overall, MCC has a worse prognosis.
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Affiliation(s)
- Julia Grabowski
- Department of Family and Preventive Medicine, University of California at San Diego School of Medicine, La Jolla, CA
| | - Sidney L Saltzstein
- Department of Family and Preventive Medicine, University of California at San Diego School of Medicine, La Jolla, CA
- Department of Pathology, University of California at San Diego School of Medicine, La Jolla, CA
- Department of Surgery, University of California at San Diego School of Medicine, La Jolla, CA
- Rebecca and John Moores UCSD Cancer Center, University of California at San Diego School of Medicine, La Jolla, CA
| | - Georgia Robins Sadler
- Department of Surgery, University of California at San Diego School of Medicine, La Jolla, CA
- Rebecca and John Moores UCSD Cancer Center, University of California at San Diego School of Medicine, La Jolla, CA
| | - Zunera Tahir
- Rebecca and John Moores UCSD Cancer Center, University of California at San Diego School of Medicine, La Jolla, CA
| | - Sarah Blair
- Department of Surgery, University of California at San Diego School of Medicine, La Jolla, CA
- Rebecca and John Moores UCSD Cancer Center, University of California at San Diego School of Medicine, La Jolla, CA
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Vesely MJJ, Murray DJ, Neligan PC, Novak CB, Gullane PJ, Ghazarian D. Complete spontaneous regression in Merkel cell carcinoma. J Plast Reconstr Aesthet Surg 2008; 61:165-71. [PMID: 17382612 DOI: 10.1016/j.bjps.2006.10.020] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2006] [Accepted: 10/15/2006] [Indexed: 11/29/2022]
Abstract
Merkel cell carcinoma is a rare, aggressive, cutaneous malignancy of the elderly with a generally poor prognosis. Like all skin cancers, its incidence is rising. A few reports of spontaneous regression have been published. The case of a 67-year-old female patient who presented with a cheek Merkel cell carcinoma is described. Following biopsy it underwent complete regression with no evidence of residual tumour in the excision specimen taken seven weeks later. The current knowledge of Merkel cell carcinoma and the other cases of spontaneous regression described in the literature are reviewed.
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Affiliation(s)
- Martin J J Vesely
- Division of Plastic Surgery, University of Toronto, University Health Network, Wharton Head & Neck Centre, Toronto, Ontario, Canada
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Torroni A, Loré B, Iannetti G. The Importance of the Head and Neck Region in Regression of Advanced MCC. J Craniofac Surg 2007; 18:1173-6. [PMID: 17912107 DOI: 10.1097/scs.0b013e31812f76c0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This paper presents the case of a 76-year-old woman who experienced a total regression of a Merkel cell carcinoma (MCC). The primary site of the tumor was on her right eyebrow. After this lesion was excised, the patient presented a massive locoregional metastasis on the right parotid gland and the laterocervical lymph nodes. No distant metastases were detected. An incisional biopsy into the right parotid gland confirmed the diagnosis of MCC metastasis. No surgical treatment was prescribed because of the advanced stage of the disease. Spontaneous total regression on the parotid and the neck mass was observed within 3 months. This is the 15th case of spontaneous regression in total and the 14th case with a site of origin in the head and neck region.
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Affiliation(s)
- Andrea Torroni
- Division of Maxillofacial Surgery, University of Rome La Sapienza Rome, Italy.
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Abstract
Merkel cell carcinoma (MCC) is a rare, aggressive cutaneous cancer that predominately affects elderly Caucasians with fair skin and has a propensity for local recurrence and regional lymph node metastases. A variety of terms have been used to describe this tumor, including trabecular cell carcinoma, neuroendocrine or primary small cell carcinoma of the skin, and anaplastic cancer of the skin. Although the skin lesion is most commonly found on sun-exposed areas of the head and neck or extremities, it can occur on the trunk, genitalia, and perianal region. The median age is 69 years, but it may occur earlier and more frequently in immunosuppressed patients. Patients with MCC frequently present with a nonspecific erythematous or violaceous firm nodule or small plaque that may be surrounded by small satellite tumors. MCC usually arises in the dermis and extends into the subcutis. It may be difficult to accurately diagnose MCC by light microscopy alone and ancillary techniques, including electron microscopy and immunohistochemistry, may be necessary to make a definitive diagnosis. Management of MCC is dependent on stage of the disease and is hampered by its rarity and lack of randomized trials. Nonetheless, for localized disease most guidelines include wide local excision of the primary tumor either alone or with radiation therapy. Sentinel lymph node biopsy can be helpful in staging and prognosis, but its benefit in survival remains to be seen. Systemic chemotherapy, akin to regimens for small cell carcinoma of the lung, may be considered as an adjuvant following surgery or to treat locoregional or distant disease. The prognosis of MCC is variable. Some patients with localized disease have an indolent course and are well controlled with local excision alone. On the other hand, many tumors are aggressive and have a tendency for locoregional recurrence and distant metastases. Such patients have a grim prognosis with a median survival of 9 months. Successful outcomes are most often seen in patients with early diagnosis and complete excision.
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Affiliation(s)
- Michael Howard Swann
- Department of Dermatology, University of Missouri-Columbia, Columbia, MO 65212, USA.
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Papageorgiou KI, Kaniorou-Larai MG. A case report of Merkel cell carcinoma on chronic lymphocytic leukemia: differential diagnosis of coexisting lymphadenopathy and indications for early aggressive treatment. BMC Cancer 2005; 5:106. [PMID: 16111484 PMCID: PMC1208865 DOI: 10.1186/1471-2407-5-106] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2005] [Accepted: 08/19/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic lymphocytic leukemia (CLL) is a monoclonal disorder, characterized by a progressive proliferation of functionally incompetent B lymphocytes. There is increased evidence of association between CLL and skin cancers, including the uncommon Merkel cell carcinoma (MCC). CASE PRESENTATION A case report of an 84-year old male, who presented with an aggressively recurrent form of MCC on the lower lip, on the background of an 8-year history of untreated CLL. During the recurrences of MCC, coexisting regional lymphadenopathy, posed a problem in the differential diagnosis and treatment of lymph node involvement. Histopathology and immunoistochemistry showed that submandibular lymphadenopathy coexisting with the second recurrence of MCC, was due to B-cell small lymphocytic lymphoma. The subsequent and more aggressive recurrence of the skin tumor had involved the superficial and deep cervical lymph nodes. Surgical excision followed by involved field radiation therapy has been proven effective for both malignancies. CONCLUSION MCC has a high incidence of regional lymphadenopathy at presentation (12-45%) and even when it arises on the background of chronic leukemia, lymphadenopathy at presentation should be managed agressively with elective lymph node dissection. We overview the postulated correlation between Merkel tumor and CCL, the differential diagnosis of regional lymphadenopathy during the recurrences of the skin tumor and the strategies of treatment.
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MESH Headings
- Aged, 80 and over
- Carcinoma, Merkel Cell/complications
- Carcinoma, Merkel Cell/diagnosis
- Diagnosis, Differential
- Humans
- Immunohistochemistry
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Lip Neoplasms/metabolism
- Lip Neoplasms/pathology
- Lymphatic Diseases/complications
- Lymphatic Diseases/diagnosis
- Lymphatic Metastasis
- Male
- Neoplasm Metastasis
- Recurrence
- Skin Neoplasms/complications
- Skin Neoplasms/diagnosis
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Affiliation(s)
- KI Papageorgiou
- St Andrews Center of Burns and Plastic Surgery, Broomfield Hospital, Court Road, Chelmsford, CM1 7ET, UK
| | - MG Kaniorou-Larai
- St Andrews Center of Burns and Plastic Surgery, Broomfield Hospital, Court Road, Chelmsford, CM1 7ET, UK
- Plastic and Reconstructive Surgery Department, "G. Gennimatas" 6IKA Oncological Hospital, 11473 Athens, Greece
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Junquera L, Torre A, Vicente JC, García-Consuegra L, Fresno MF. Complete spontaneous regression of Merkel cell carcinoma. Ann Otol Rhinol Laryngol 2005; 114:376-80. [PMID: 15966524 DOI: 10.1177/000348940511400507] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Merkel cell carcinoma (MCC) is a very aggressive primary cutaneous neoplasm most often occurring on the head and neck of the elderly. Spontaneous regression of MCC was first described in 1986. A 79-year-old woman with MCC on the right cheek underwent spontaneous regression of the malignancy, documented by photographic follow-up, computed tomography, and histologic studies. A review of the literature is presented. Complete clinical and histologic regression of MCC was observed in the present case. Although the literature documents 11 similar cases, only 6 can be regarded as complete spontaneous regressions following exclusive performance of a biopsy (primary complete spontaneous regression). Primary complete spontaneous regression of MCC is infrequent, and most case reports describe this phenomenon in women with MCC on the cheek. The reasons underlying regression are unknown.
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Affiliation(s)
- Luis Junquera
- Department of Oral and Maxillofacial Surgery, University of Oviedo, Central Hospital of Asturias, Oviedo, Spain
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26
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Eng TY, Naguib M, Fuller CD, Jones WE, Herman TS. Treatment of Recurrent Merkel Cell Carcinoma: An Analysis of 46 Cases. Am J Clin Oncol 2004; 27:576-83. [PMID: 15577435 DOI: 10.1097/01.coc.0000135926.93116.c7] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This report describes the course of recurrent Merkel cell carcinoma and defines possible treatment strategies for recurrent disease as seen in a long-term multisite retrospective analysis. Merkel cell carcinoma is a highly aggressive neuroendocrine skin cancer. Surgery and radiation therapy have been demonstrated ability to control this disease; however, recurrence is common. Systemic chemotherapy has, as yet, no presently defined role in primary treatment, and few conclusions can be reached regarding optimal treatment of disease recurrence. Forty-six patients were identified over the last 15 years in a retrospective analysis of patient records from several hospitals in the San Antonio, TX area. Hospital charts as well as outpatient treatment records were reviewed. Almost all patients developing recurrent disease did so within the first 2 years after primary treatment. Patients presenting distant disease had a median survival of 12 months, faring worse than those who display local or nodal disease. For patients with nodal or local recurrence, the mean survival after combination therapy (chemotherapy, radiation +/- surgery) was 36.5 months as compared with 17.5 months for those treated with a single modality (surgery or radiation or chemotherapy). The overall survival rate for the 46 patients with recurrence was 37%. Multimodality therapy has shown the best results for recurrent Merkel cell carcinoma thus far, and should be used if tolerated by the patient. Aggressive salvage surgery for local or nodal recurrence is encouraged, because this disease has a tendency to become more destructive upon recurrence. Adjuvant radiation therapy should also be used, if the patient has not exceeded their dose limitations. Disseminated disease, whether primary or recurrent, warrants further investigation in terms of optimal treatment.
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Affiliation(s)
- Tony Y Eng
- Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
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27
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Abstract
Although neural and neuroendocrine tissues are distributed virtually ubiquitously throughout the body, the occurrence of selected neoplasms related to those lineages is extremely uncommon in some topographic sites. This review considers the clinicopathologic characteristics of heterotopic pituitary adenomas; neuroendocrine carcinomas in non-organ-based locations; ectopic (extraneuraxial) meningiomas and gliomas; visceral neuroblastic neoplasms and primitive neuroectodermal tumors; and paragangliomas arising outside the sympathoadrenal neural network. Practical approaches to differential diagnosis are emphasized.
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Affiliation(s)
- Mark R Wick
- Division of Surgical Pathology & Cytopathology, Department of Pathology, University of Virginia Health System, Charlottesville, VA 22908-0214, USA.
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28
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Abstract
Merkel cell carcinoma is a rare cutaneous neoplasm most commonly affecting the head and neck of elderly white patients. Even with treatment, Merkel cell carcinoma has a strong propensity toward local recurrence, lymphatic spread, and distant metastasis. Because of its rarity and the subsequent lack of well-controlled clinical trials, no single standard of care exists for the treatment of this aggressive tumor. In our institution, primary lesions are excised with wide margins or by Mohs' micrographic surgery. After local removal, the excision site is treated locally with external radiation therapy. Sentinel lymph node mapping and biopsy are performed. Patients with tumor within a sentinel lymph node undergo lymph node dissection and radiation to the lymphatic basin. Adjuvant chemotherapy is offered to high-risk patients with local disease and to patients with metastases. Patients with distant metastases are treated with a combination of salvage chemotherapy and radiation therapy.
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Affiliation(s)
- Michael S Lehrer
- Department of Dermatology, Hospital of the University of Pennsylvania, 2 Maloney Building, 3600 Spruce Street, Philadelphia, PA 19104, USA
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29
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Bickle K, Glass LF, Messina JL, Fenske NA, Siegrist K. Merkel cell carcinoma: a clinical, histopathologic, and immunohistochemical review. ACTA ACUST UNITED AC 2003; 23:46-53. [PMID: 15095915 DOI: 10.1016/s1085-5629(03)00087-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Merkel cell carcinoma is a rare aggressive neoplasm, with about 400 cases diagnosed in the United States each year. Among the cutaneous-derived neoplasms, it is the most deadliest, with a higher mortality rate than melanoma. Although the classic clinical presentation as a rapidly growing papule in a sun-exposed site of an elderly patient is not specific, certain histopathologic and ancillary pathologic features allow for its discrimination in most cases. Herein, we review the etiology, pathogenesis, clinical, and pathologic attributes as well as the staging treatment and prognosis of this important public health menace.
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Affiliation(s)
- Kelly Bickle
- Divison of Dermatology, Department of Internal Medicine, University of South Florida College of Medicine, 12901 Bruce D. Downs Blvd, MDC 19, Tampa, FL 33612-4799, USA
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Eich HT, Eich D, Staar S, Mauch C, Stützer H, Groth W, Krieg T, Müller RP. Role of postoperative radiotherapy in the management of Merkel cell carcinoma. Am J Clin Oncol 2002; 25:50-6. [PMID: 11823697 DOI: 10.1097/00000421-200202000-00011] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine tumor of the skin with a high potential of locoregional relapse after surgery alone. This report is an update of our experience in the treatment of MCC. From January 1990 to May 2000, 31 patients with MCC, 13 men and 18 women aged between 34 and 92 years, were treated at the University of Cologne, Germany. Primary tumor sites were in the head and neck region in 13 patients, limbs in 13, and trunk in 5. The tumors were stage I in 26 of 31 patients, stage II in 4 of 31 and stage III in 1 of 31. Treatment included surgery alone in 14 of 31 patients, adjuvant postoperative radiotherapy in 16 of 31 patients, 1 of them had incomplete surgery, and definitive radiotherapy in 1 of 31 patients (stage III). Median overall survival (OS) after first diagnosis was 32 months (95% confidence interval: 0-75 months) with a 3-year OS rate of 47% (95% CI: 25-69%). Six of 31 patients relapsed locally after a median of 4 months, 10 of 31 patients developed regional node metastases, and 7 of 31 patients distant metastases. Nine patients died as a direct result of MCC. Locoregional control and disease-free survival were significantly improved in the group with postoperative radiotherapy (p = 0.023). Uni- and multivariate analysis revealed that head and neck location of the tumor and the lack of postoperative radiotherapy are unfavorable prognostic factors. Postoperative radiotherapy to the primary tumor region and the regional lymphatics is effective in the prevention of locoregional recurrence. Prospective clinical trials should be performed to confirm these observations.
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Affiliation(s)
- Hans Theodor Eich
- Department of Radiotherapy, University of Cologne, Joseph-Stelzmann Strasse 9, D-50924 Cologne, Germany
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31
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Turgut M, Gökpinar D, Barutça S, Erkuş M. Lumbosacral metastatic extradural Merkel cell carcinoma causing nerve root compression--case report. Neurol Med Chir (Tokyo) 2002; 42:78-80. [PMID: 11944594 DOI: 10.2176/nmc.42.78] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 63-year-old man presented with a rare metastatic Merkel cell carcinoma (MCC) involving the lumbosacral spine and causing nerve root compression. Magnetic resonance (MR) imaging revealed an extradural soft tissue mass at the L5-S1 levels. The tumor was subtotally removed and chemotherapy was administered, but he died of multiple metastases from the primary epigastric tumor. Lumbosacral metastatic epidural tumor can manifest as lumbar disc disease symptoms, but MR imaging can non-invasively and rapidly reveal the presence of spinal epidural tumor and any extension to the spinal canal. Extradural MCC metastasis in the lumbosacral area should be considered in the differential diagnosis of radicular symptoms caused by disc herniation.
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Affiliation(s)
- Mehmet Turgut
- Neurosurgery Department, Adnan Menderes University Hospital, Aydin, Turkey.
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Sais G, Admella C, Soler T. Spontaneous regression in primary cutaneous neuroendocrine (Merkel cell) carcinoma: a rare immune phenomenon? J Eur Acad Dermatol Venereol 2002; 16:82-3. [PMID: 11952300 DOI: 10.1046/j.1468-3083.2002.374_2.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Merkel cell carcinoma has been found to have an increased incidence among immunosuppressed patients, specifically organ transplant recipients receiving immunosuppressive therapy. HIV similarly depresses the immune response of infected persons. We report a case of Merkel cell carcinoma (MCC) in an HIV-infected patient who died from liver metastases 2 years after his tumor was diagnosed. The purpose of this report is to describe the possible relationship between HIV and MCC and to emphasize the importance of early diagnosis and aggressive management of MCC.
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Affiliation(s)
- K P An
- Department of Dermatology, College of Physicians and Surgeons of Columbia University, New York, NY, USA
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Snow SN, Larson PO, Hardy S, Bentz M, Madjar D, Landeck A, Oriba H, Olansky D. Merkel cell carcinoma of the skin and mucosa: report of 12 cutaneous cases with 2 cases arising from the nasal mucosa. Dermatol Surg 2001; 27:165-70. [PMID: 11207692 DOI: 10.1046/j.1524-4725.2001.00189.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is an uncommon skin tumor that most frequently arises on sun-exposed facial sites. It rarely occurs on mucous membranes of the head region. The primary MCC is usually treated by wide excision followed by radiation to the primary site and regional lymph nodes. Using traditional surgery the local recurrence rate ranges from 20 to 50%. In our clinic, Mohs surgery is used to excise the primary MCC completely, followed by radiation. Here we present our treatment experiences and outcomes. OBJECTIVE To document our experience of MCC treated by Mohs surgery. We present our series of 12 cases of MCC, 2 cases of which arose from mucosal sites of the nasal cavity. METHODS We reviewed 12 cases of MCC from the Mohs clinic database. We also reviewed the literature for cutaneous and mucosal MCC. RESULTS There were 12 cases of MCC: 10 cutaneous and 2 mucous. The site distribution of cutaneous MCC was eight on the head, one on the neck, and one on the groin. Of these, nine were treated by Mohs excision. Two patients developed local recurrence following Mohs treatment. The local recurrence rate was 22% (2 of 9). The sites of mucosal MCC were the nasal septum and nasopharynx. One case had a history of previous radiation and developed an MCC 40 years later. This case also demonstrated epidermotropic spread of Merkel cells to the overlying mucous epithelium. This patient required extensive intranasal and cranial surgery to remove the tumor. Both patients with mucosal MCCs died of their disease. The overall mucocutaneous survival of MCC at 1 year was 80% and at 2 years was 50%. CONCLUSION In our series, local control of the primary MCC was achieved in 70% of patients (7 of 10) using combined Mohs excision and radiation. Two recurrences had primary tumors larger than 3.5 cm in diameter, while the other case was nonresectable by Mohs surgery. Tumor size appeared to determine the degree of local control. When the postoperative Mohs defect was less than 3.0 cm in diameter, local and regional control appeared to be more favorable. When the primary facial MCC is relatively small, removal by Mohs surgery followed by radiation was effective, therapeutic, and less disfiguring. Mucosal MCC is rare and may occur as a long-term sequelae after radiation therapy to the skin.
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Affiliation(s)
- S N Snow
- Division of Plastic Surgery, Section of Mohs Surgery, Department of Surgery, University of Wisconsin-Madison, School of Medicine, Madison, Wisconsin 53705, USA
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35
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SNOW STEPHENN, LARSON PAULO, HARDY STEPHEN, BENTZ MICHAEL, MADJAR DAVID, LANDECK ANYA, ORIBA HOWARD, OLANSKY DAVID. Merkel Cell Carcinoma of the Skin and Mucosa. Dermatol Surg 2001. [DOI: 10.1097/00042728-200102000-00014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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36
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Connelly TJ, Cribier B, Brown TJ, Yanguas I. Complete spontaneous regression of Merkel cell carcinoma: a review of the 10 reported cases. Dermatol Surg 2000; 26:853-6. [PMID: 10971559 DOI: 10.1046/j.1524-4725.2000.00054.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Merkel cell (neuroendocrine) carcinoma (MCC) is a very aggressive primary cutaneous neoplasm occurring most often on the head and neck of the elderly. Complete spontaneous regression (CSR) of MCC was first described in 1986. Since then other cases have been reported bringing the total to 10. OBJECTIVE To review these 10 cases and obtain long-term follow-up data, to compare them for similarities and differences. METHOD Each original case report was extensively reviewed and authors contacted in most cases for confirmation and updated information. RESULTS In no case did MCC recur after CSR was noted, although follow-up information in some cases was short. When CSR occurred, it was swift and dramatic with complete regression of skin and lymph node metastasis in 1-3 months. CONCLUSION While only 10 cases of CSR is a small number, MCC is itself a rare malignancy with just over 600 reported cases. Today most cases of MCC receive aggressive combined therapy effectively precluding diagnosis of CSR. The nature of regression in these 10 cases may point toward future immunologic therapy just as similar cases of CRS in patients with melanoma have led to advances in the immunologic treatment for that malignancy.
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Affiliation(s)
- T J Connelly
- Connelly Skin Cancer Surgery Center, Stuart, Florida, USA.
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Zeitouni NC, Cheney RT, Delacure MD. Lymphoscintigraphy, sentinel lymph node biopsy, and Mohs micrographic surgery in the treatment of Merkel cell carcinoma. Dermatol Surg 2000; 26:12-8. [PMID: 10632680 DOI: 10.1046/j.1524-4725.2000.99129.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is an aggressive cutaneous malignancy with a high incidence of occult nodal metastases. MCC is believed to be similar in natural history to thick or ulcerated melanomas in its propensity for locoregional recurrence and early lymph node metastasis. Studies have shown that nodal status is statistically correlated to survival in MCC. Radiolocalization and superselective lymph node biopsy is a recent technique that has been proven to be of great value in evaluating the status of occult lymph node disease in malignant melanoma and breast cancer patients. OBJECTIVE In previously untreated patients, an orderly progression of metastases is observed for both cutaneous carcinomas and malignant melanomas and is anticipated for MCC. METHODS/RESULTS. We present two patients with MCC of the head and neck who underwent simultaneous Mohs micrographic surgery and sentinel lymph node biopsy with intraoperative radiolocalization. CONCLUSION Sentinel lymph node biopsy and intraoperative lymphoscintigraphy may prove to be a useful technique in evaluating occult nodal involvement and in limiting the potentially unnecessary morbidity of more comprehensive lymph node dissections in MCC patients who do not yet have metastatic involvement.
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Affiliation(s)
- N C Zeitouni
- Department of Dermatology, Roswell Park Cancer Insititute, Buffalo, New York, USA.
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