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Moon IJ, Na H, Cho HS, Won CH, Chang SE, Lee MW, Lee WJ. Clinicopathological characteristics and prognosis of Merkel cell carcinoma: a single-center retrospective study in Korea. J Cancer Res Clin Oncol 2023; 149:10065-10074. [PMID: 37261524 DOI: 10.1007/s00432-023-04932-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/23/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is an aggressive neuroendocrine tumor of the skin with high mortality. However, its clinical characteristics in Asian patients remain uncertain owing to its low incidence. OBJECTIVE To analyze the clinicopathological features of MCC and identify factors associated with its prognosis. METHODS The medical records of 62 patients with MCC were retrospectively reviewed. Data on clinical features, survival outcomes, prognostic factors, histopathology and immunohistochemical profile of the patients were collected and analyzed. Merkel cell polyomavirus status was evaluated using immunohistochemistry. RESULTS The incidence of MCC significantly increased over time. The mean duration of follow-up was 51.2 months, with an overall 5-year survival of 80.6%. More female patients with MCC were identified than male patients (1.3:1). Approximately half of the patients had stage I disease at the time of initial presentation. The primary tumor was frequently located in the lower extremities (40.3%), followed by the head and neck (32.3%), upper extremities (22.6%), and the trunk (4.8%). Male sex was associated with poorer overall survival (p = 0.003). Post-resection adjuvant radiotherapy significantly improved the overall survival (p = 0.023). Sentinel lymph node biopsy during surgery ameliorated the progression-free survival (p = 0.036) in patients with stage I or II cancer. Lymphovascular and perineural invasion were associated with a poor prognosis. Old age, immunohistochemical profiles, and Merkel cell polyomavirus-positivity were not associated with prognosis. CONCLUSION Post-surgical adjuvant radiotherapy and sentinel lymph node biopsy significantly improve the course of MCC.
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Affiliation(s)
- Ik Jun Moon
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-Gil, Songpa-gu, Seoul, 05505, South Korea
| | - Hyungmin Na
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-Gil, Songpa-gu, Seoul, 05505, South Korea
| | - Hye Soo Cho
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-Gil, Songpa-gu, Seoul, 05505, South Korea
| | - Chong Hyun Won
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-Gil, Songpa-gu, Seoul, 05505, South Korea
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-Gil, Songpa-gu, Seoul, 05505, South Korea
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-Gil, Songpa-gu, Seoul, 05505, South Korea
| | - Woo Jin Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-Gil, Songpa-gu, Seoul, 05505, South Korea.
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Gomez K, Schiavoni G, Nam Y, Reynier JB, Khamnei C, Aitken M, Palmieri G, Cossu A, Levine A, van Noesel C, Falini B, Pasqualucci L, Tiacci E, Rabadan R. Genomic landscape of virus-associated cancers. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.14.23285775. [PMID: 36824731 PMCID: PMC9949223 DOI: 10.1101/2023.02.14.23285775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
It has been estimated that 15%-20% of human cancers are attributable to infections, mostly by carcinogenic viruses. The incidence varies worldwide, with a majority affecting developing countries. Here, we present a comparative analysis of virus-positive and virus-negative tumors in nine cancers linked to five viruses. We find that virus-positive tumors occur more frequently in males and show geographical disparities in incidence. Genomic analysis of 1,658 tumors reveals virus-positive tumors exhibit distinct mutation signatures and driver gene mutations and possess a lower somatic mutation burden compared to virus-negative tumors of the same cancer type. For example, compared to the respective virus-negative counterparts, virus-positive cases across different cancer histologies had less often mutations of TP53 and deletions of 9p21.3/ CDKN2 A- CDKN1A ; Epstein-Barr virus-positive (EBV+) gastric cancer had more frequent mutations of EIF4A1 and ARID1A and less marked mismatch repair deficiency signatures; and EBV-positive cHL had fewer somatic genetic lesions of JAK-STAT, NF-κB, PI3K-AKT and HLA-I genes and a less pronounced activity of the aberrant somatic hypermutation signature. In cHL, we also identify germline homozygosity in HLA class I as a potential risk factor for the development of EBV-positive Hodgkin lymphoma. Finally, an analysis of clinical trials of PD-(L)1 inhibitors in four virus-associated cancers suggested an association of viral infection with higher response rate in patients receiving such treatments, which was particularly evident in gastric cancer and head and neck squamous cell carcinoma. These results illustrate the epidemiological, genetic, prognostic, and therapeutic trends across virus-associated malignancies.
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Yang A, Wijaya WA, Yang L, He Y, Cen Y, Chen J. The impact of merkel cell polyomavirus positivity on prognosis of merkel cell carcinoma: A systematic review and meta-analysis. Front Oncol 2022; 12:1020805. [PMID: 36248985 PMCID: PMC9562919 DOI: 10.3389/fonc.2022.1020805] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction There are numerous findings over the past decade have indicated that Merkel cell carcinoma (MCC) may have two pathways of pathogenesis: one related to ultraviolet irradiation and the other to the Merkel cell polyomavirus (MCPyV). However, the predictive and clinicopathological value of MCPyV positivity in MCC patients is still debatable. This article aims to examine the most recent data regarding this issue. Methods The thorough literature searches were conducted in the Medline Ovid, PubMed, Web of Science, the Cochrane CENTRAL Databases, and Embase Databases until December 31, 2021. The associations between overall survival (OS), Merkel cell carcinoma-specific survival (MSS), recurrence-free survival (RFS), progression-free survival (PFS), clinicopathologic features, and MCPyV positivity were examined in our meta-analysis. Results This meta-analysis included a total of 14 studies involving 1595 patients. Our findings demonstrated a significant correlation between MCPyV positivity and improved OS (HR=0.61, 95%CI:0.39-0.94, P=0.026) and improved PFS (HR=0.61, 95% CI: 0.45-0.83, P=0.002). MCPyV positivity did not, however, appear to be associated with either MSS (HR=0.61, 95%CI: 0.28-1.32, P=0.209) or RFS (HR= 0.93, 95%CI: 0.37-2.34, P=0.873). Pooled results revealed a correlation between MCPyV positivity with gender (male vs. female, OR=0.606, 95%CI: 0.449-0.817, P=0.001), histopathological stage (AJCC I-II vs. III-IV, OR=1.636, 95%CI: 1.126-2.378, P=0.010) and primary site (head and neck vs. other sites, OR=0.409, 95%CI: 0.221-0.757, P=0.004). Conclusion These results imply that MCPyV positivity may present a promising predictive biomarker for human MCC and call for further study.
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Affiliation(s)
- Aimin Yang
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Wilson Adrian Wijaya
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Yang
- West China School of Stomatology Sichuan University, Chengdu, China
| | - Yinhai He
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ying Cen
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Ying Cen, ; Junjie Chen,
| | - Junjie Chen
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Ying Cen, ; Junjie Chen,
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Rolph KE, Cavanaugh RP. Infectious Causes of Neoplasia in the Domestic Cat. Vet Sci 2022; 9:vetsci9090467. [PMID: 36136683 PMCID: PMC9506438 DOI: 10.3390/vetsci9090467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/28/2022] [Accepted: 08/28/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Increasingly, cancers are being linked to infections with viruses, bacteria, and parasites in human medicine. This review summarises the current literature regarding neoplasia occurring in association with infectious diseases in domestic cats. To date, most studies have focused on the role of viruses, especially feline leukaemia virus and feline immunodeficiency virus in association with lymphoma, or the role of papillomavirus in cutaneous and oral neoplasms in cats. Recently, there has been a focus on a potential role of mouse mammary tumour virus in feline mammary carcinoma and lymphoma and studies assessing the potential role of gammaherpes virus and hepadnaviruses in feline neoplasia. Additionally, there has been some focus on potential bacterial and parasitic associations with neoplasia; including reports assessing potential associations between Helicobacter species and gastrointestinal neoplasms, and case reports of neoplasia in association with Platynosomum fastosum and Opisthorchis viverrini. Abstract In recent years, growing attention has been paid to the influence/role of infectious diseases in tumour development and progression. Investigations have demonstrated that some infectious organisms can have a direct role in the development of neoplasia, whereas others can predispose to neoplasia by alterations in the immune response, or by creating a pro-inflammatory environment. Feline leukaemia virus was one of the first infectious agents recognised as an oncogenic organism, and along with feline immunodeficiency virus has received the most attention. Since the discovery of this retrovirus, several other organisms have been associated with neoplastic processes in cats, these include gammaherpes virus, mouse mammary tumour virus, papillomaviruses, hepadnavirus, Helicobacter species, and the parasitic infections Platynosomum fastosum and Opisthorchis viverrini. This review summarises the findings to date.
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Ali A, Ara A, Kashyap MK. Gut microbiota: Role and Association with Tumorigenesis in Different Malignancies. Mol Biol Rep 2022; 49:8087-8107. [PMID: 35543828 DOI: 10.1007/s11033-022-07357-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/01/2022] [Accepted: 03/10/2022] [Indexed: 02/07/2023]
Abstract
The microbiota has been associated with different cancer and may vary from patient to patient. A specific microbial strain can alter the progression of cancer and therapeutic outcome in response to anti-cancer therapy. The variations in microbiota contributed due to the individual microbiome of the microorganism are responsible for diverse clinical outcomes. The expansion of microbiota subpopulation during dysbiosis can lead to toxin production, inducing inflammation and cancer. The microbiota can be a dual-edged sword because it can be tumor-suppressive or oncogenic in the case of the gut. The transition of cancer cells from early to late-stage also impacts the composition of the microbiota, and this alteration could change the behavior of cancer. Multi-omics platforms derived data from an individual's multi-dimensional data (DNA, mRNA, microRNA, protein, metabolite, microbiota, and microbiome), i.e., individualome, to exploit it for personalized tailored treatment for different cancers in a precise manner. A number of studies suggest the importance of microbiota and its add-in suitability to existing treatment options for different malignancies. Furthermore, in vitro, and in vivo studies and cancer clinical trials suggest that probiotics have driven modulation of gut microbiota and other sites discourage the aggressive behavior and progression of different cancers.
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Affiliation(s)
- Altamas Ali
- Department of Biosciences, Jamia Millia Islamia (A central University), Jamia Nagar, 110025, New Delhi, India
| | - Anam Ara
- Department of Biosciences, Jamia Millia Islamia (A central University), Jamia Nagar, 110025, New Delhi, India
| | - Manoj Kumar Kashyap
- Amity Stem Cell Institute/Amity Medical School, Amity University Haryana, Amity Education Valley, Panchgaon (Manesar), Gurugram, HR, 122413, India.
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Wijaya WA, Liu Y, Qing Y, Li Z. Prevalence of Merkel Cell Polyomavirus in Normal and Lesional Skin: A Systematic Review and Meta-Analysis. Front Oncol 2022; 12:868781. [PMID: 35392226 PMCID: PMC8980839 DOI: 10.3389/fonc.2022.868781] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/28/2022] [Indexed: 02/05/2023] Open
Abstract
The prevalence of Merkel cell polyomavirus(MCPyV) in Merkel cell carcinoma(MCC) and non-MCC skin lesions and its possible role in the etiology of other skin diseases remain controversial. To systematically assess the association between MCPyV infection and MCC, non-MCC skin lesions, and normal skin. For this systematic review and meta-analysis, a comprehensive search for eligible studies was conducted using Medline Ovid, Pubmed, Web of Science, and the Cochrane CENTRAL databases until August 2021; references were searched to identify additional studies. Observational studies that investigated the association between MCPyV infection and MCC, non-MCC skin lesions, and normal skin using polymerase chain reaction(PCR) as a detection method and provided sufficient data to calculate the prevalence of MCPyV positivity. A total of 50 articles were included in the study after exclusion criteria were applied. Two reviewers independently reviewed and assessed the eligibility of the studies, and all disagreements were resolved by consensus. To determine the association between MCPyV and MCC, overall odds ratio (OR) were calculated with 95% CI using a random-effects model. Single-arm meta-analyses were performed to examine the prevalence rate of MCPyV+ in MCC, non-MCC skin lesions, and normal skin. The primary analysis was the prevalence rate of MCPyV+ in MCC. Secondary outcomes included the prevalence rate of MCPyV+ in non-MCC skin lesions and normal skin. A total of 50 studies involving 5428 patients were reviewed based on our inclusion and exclusion criteria. Compared with the control group, MCPyV infection was significantly associated with MCC (OR = 3.51, 95% CI = 2.96 - 4.05). The global prevalence of MCPyV+ in MCC, melanoma, squamous cell carcinoma, basal cell carcinoma, Bowen's disease, actinic keratosis, keratoacanthoma, seborrheic keratosis, and normal skin was 80%, 4%, 15%, 15%, 21%, 6%, 20%, 10%, and 11%, respectively. The current results suggest that MCPyV infection is significantly associated with an increased risk of MCC. However, the low prevalence rate of MCPyV+ in non-MCC skin lesions does not exclude a pathogenic association of this virus with the development of non-MCC skin lesions.
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Affiliation(s)
- Wilson A Wijaya
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Liu
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Qing
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhengyong Li
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
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Garcia GA, Kossler AL. Avelumab as an Emerging Therapy for Eyelid and Periocular Merkel Cell Carcinoma. Int Ophthalmol Clin 2020; 60:91-102. [PMID: 32205656 PMCID: PMC7101017 DOI: 10.1097/iio.0000000000000306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Merkel cell carcinoma (MCC) is a highly aggressive cutaneous malignancy, with a high metastasis rate and a significant proportion of cases affecting the eyelid or periocular region. Current treatments for periocular MCC include wide local excision (WLE) with or without adjuvant radiotherapy and can result in profound morbidity and visual deficit. Metastatic disease has been traditionally treated with chemotherapy, though durable responses are typically poor and toxicity is high. Avelumab (Bavencio®, Merck KgaA, Darmstadt, Germany and Pfizer Inc., New York, NY, USA), the first FDA-approved human anti-programmed death-ligand 1 (PD-L1) antibody for the treatment of metastatic MCC (mMCC), has demonstrated safety and efficacy as first-line treatment and in chemotherapy-refractory cases. This review summarizes pivotal clinical trial data for avelumab in the treatment of mMCC, including efficacy, safety and tolerability, and describes the efficacy of two other immune checkpoint inhibitors, pembrolizumab (Keytruda®, Merck & Co., Inc., Kenilworth, NJ, USA) and nivolumab (Opdivo®, Bristol‐Myers Squibb, New York, NY, USA and Ono Pharmaceuticals, Trenton, NJ, USA) for the treatment of advanced MCC. Our purpose is to provide the rationale to further investigate avelumab as a potential therapy for advanced or metastatic eyelid and periocular MCC.
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Affiliation(s)
- Giancarlo A. Garcia
- Department of Ophthalmology, Byers Eye Institute at Stanford University, Palo Alto, California
| | - Andrea Lora Kossler
- Department of Ophthalmology, Byers Eye Institute at Stanford University, Palo Alto, California
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Sander MA, Sander MS, Isaac-Renton JL, Croxen MA. The Cutaneous Microbiome: Implications for Dermatology Practice. J Cutan Med Surg 2019; 23:436-441. [DOI: 10.1177/1203475419839939] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The human integument is inhabited by a vast array of microorganisms known collectively as the cutaneous microbiome. As a result of advances in laboratory science, our understanding of the diversity and complexity of the human microbiome is rapidly evolving. In particular, advances in the field of genomics have enabled the study of the cutaneous microbiome with a hitherto unimaginable level of detail, resulting in a maturation of our understanding of cutaneous health and disease. Herein, we review current microbiology concepts and highlight the key features of recent laboratory advances, particularly with respect to genomics. We provide a summary of new findings related to normal skin flora, interactions between host immunity and microbial communities, and microbial relationships with common skin disorders. Finally, we review the implications for dermatologists.
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Affiliation(s)
- Megan A. Sander
- Section of Dermatology, Department of Medicine, University of Calgary, AB, Canada
| | | | - Judith L. Isaac-Renton
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Matthew A. Croxen
- Provincial Laboratory for Public Health (ProvLab), Alberta Public Laboratories, Edmonton, AB, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
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Neto CF, Oliveira WRP, Costa PVA, Cardoso MK, Barreto PG, Romano CM, Urbano PR. The first observation of the association of Merkel cell polyomavirus and Merkel cell carcinoma in Brazil. Int J Dermatol 2019; 58:703-706. [DOI: 10.1111/ijd.14325] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/28/2018] [Accepted: 11/14/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Cyro Festa Neto
- Department of Dermatology Clinics Hospital of the Medical School University of São Paulo São Paulo Brazil
| | - Walmar R. P. Oliveira
- Department of Dermatology Clinics Hospital of the Medical School University of São Paulo São Paulo Brazil
| | - Pedro V. A. Costa
- Department of Dermatology Clinics Hospital of the Medical School University of São Paulo São Paulo Brazil
| | - Melina K. Cardoso
- Department of Dermatology Clinics Hospital of the Medical School University of São Paulo São Paulo Brazil
| | - Paula G. Barreto
- Department of Dermatology Clinics Hospital of the Medical School University of São Paulo São Paulo Brazil
| | - Camila M. Romano
- Virology Medical Research Laboratory Institute of Tropical Medicine University of São Paulo São Paulo Brazil
| | - Paulo R. Urbano
- Virology Medical Research Laboratory Institute of Tropical Medicine University of São Paulo São Paulo Brazil
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Iuliano A, Tranfa F, Clemente L, Fossataro F, Strianese D. A case series of Merkel cell carcinoma of the eyelid: a rare entity often misdiagnosed. Orbit 2018; 38:395-400. [PMID: 30373432 DOI: 10.1080/01676830.2018.1537291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Merkel cell carcinoma (MCC) is one of the rarest eyelid tumors, with high mortality rate due to lymphatic and metastatic spread. We hereby report six cases of patients with histological diagnosis of MCC referred to our Orbit Unit between 2012 and 2018, focusing on diagnosis, treatment, and subsequent follow up. All patients underwent surgical excision and systemic work-up. Both MCC TNM and eyelid MCC TNM were used to stage lesions. MCC of the eyelid is usually misdiagnosed as benign or other malignant lesions. A prompt examination and a wide local excision are mandatory. A close follow-up of these patients is advised due to high recurrence rate and lymphatic spread.
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Affiliation(s)
- Adriana Iuliano
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II , Naples , Italy
| | - Fausto Tranfa
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II , Naples , Italy
| | - Lidia Clemente
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II , Naples , Italy
| | - Federica Fossataro
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II , Naples , Italy
| | - Diego Strianese
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II , Naples , Italy
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Coutinho F, Horta M, Rocha E, Vasconcelos C, Araújo A. Merkel cell carcinoma and the challenge in its approach: a review based on a clinical context of immunosuppression. Porto Biomed J 2018; 3:e11. [PMID: 31595235 PMCID: PMC6726304 DOI: 10.1016/j.pbj.0000000000000011] [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] [Received: 04/24/2018] [Accepted: 05/04/2018] [Indexed: 12/03/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine cancer with high rate to local relapse and metastasis. Its connection to immunosuppression is well known, with reported association to human immunodeficiency virus (HIV). The authors present an 87-year-old woman, infected by HIV type 2 at advanced stage of the disease, whom presented a painless papule on left cheek in 2011. After its total excision, the histopathology confirmed MCC “in situ,” with no regional or distant metastases. Simultaneously, she revealed a viral load of 2220 copies/mL and 224 CD4/mm3. Five months later, the patient presented a local and distance relapse with an aggressive behavior and positive regional lymph node. Stage IV disease was confirmed due to presence of liver metastases. Concurrently to the relapse, it was detected low CD4 levels. In our multidisciplinary team decision meeting, it has been decided conservative treatment due to low Karnofsky status, comorbidities, and stage of disease.
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Affiliation(s)
| | | | | | - Carlos Vasconcelos
- Unit of Clinical Immunology; Centro Hospitalar do Porto, Oporto, Portugal
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Prognostic Value of the Staging System for Eyelid Tumors in the 7th Edition of the American Joint Committee on Cancer Staging Manual. Ophthalmic Plast Reconstr Surg 2017; 33:317-324. [DOI: 10.1097/iop.0000000000000901] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Merkel cell polyomavirus and cutaneous Merkel cell carcinoma. Future Sci OA 2017; 2:FSO155. [PMID: 28116137 PMCID: PMC5242196 DOI: 10.4155/fsoa-2016-0064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 10/10/2016] [Indexed: 02/07/2023] Open
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14
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Hoerster R, Schlaak M, Koch KR, Ortmann M, Mauch C, Heindl LM. Merkel-Zell-Karzinom des Augenlids – eine häufig verkannte Diagnose. Ophthalmologe 2016; 114:134-139. [DOI: 10.1007/s00347-016-0355-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Liu W, MacDonald M, You J. Merkel cell polyomavirus infection and Merkel cell carcinoma. Curr Opin Virol 2016; 20:20-27. [PMID: 27521569 DOI: 10.1016/j.coviro.2016.07.011] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 07/26/2016] [Accepted: 07/28/2016] [Indexed: 12/17/2022]
Abstract
Merkel cell polyomavirus is the only polyomavirus discovered to date that is associated with a human cancer. MCPyV infection is highly prevalent in the general population. Nearly all healthy adults asymptomatically shed MCPyV from their skin. However, in elderly and immunosuppressed individuals, the infection can lead to a lethal form of skin cancer, Merkel cell carcinoma. In the last few years, new findings have established links between MCPyV infection, host immune response, and Merkel cell carcinoma development. This review discusses these recent discoveries on how MCPyV interacts with host cells to achieve persistent infection and, in the immunocompromised population, contributes to MCC development.
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Affiliation(s)
- Wei Liu
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Margo MacDonald
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jianxin You
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Grice EA. The intersection of microbiome and host at the skin interface: genomic- and metagenomic-based insights. Genome Res 2016; 25:1514-20. [PMID: 26430162 PMCID: PMC4579337 DOI: 10.1101/gr.191320.115] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The past two decades have been marked by a surge in research to understand the microbial communities that live in association with the human body, in part stimulated by affordable, high-throughput DNA sequencing technology. In the context of the skin, this Perspective focuses on the current state of genomic- and metagenomic-based host–microbe research and future challenges and opportunities to move the field forward. These include elucidating nonbacterial components of the skin microbiome (i.e., viruses); systematic studies to address common perturbations to the skin microbiome (e.g., antimicrobial drugs, topical cosmetic/hygienic products); improved approaches for identifying potential microbial triggers for skin diseases, including species- and strain-level resolution; and improved, clinically relevant models for studying the functional and mechanistic roles of the skin microbiome. In the next 20 years, we can realistically expect that our knowledge of the skin microbiome will inform the clinical management and treatment of skin disorders through diagnostic tests to stratify patient subsets and predict best treatment modality and outcomes and through treatment strategies such as targeted manipulation or reconstitution of microbial communities.
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Affiliation(s)
- Elizabeth A Grice
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19014, USA
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18
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Porceddu SV, Veness MJ, Guminski A. Nonmelanoma Cutaneous Head and Neck Cancer and Merkel Cell Carcinoma: Current Concepts, Advances, and Controversies. J Clin Oncol 2015; 33:3338-45. [PMID: 26351348 DOI: 10.1200/jco.2014.60.7333] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Nonmelanoma skin cancer (NMSC) is the most common cancer worldwide and the most frequently observed malignancy in whites. Approximately 75% to 80% are basal cell carcinomas and 20% to 25% are squamous cell carcinomas. Incidence is increasing, partly reflecting an ageing population, and NMSC is more commonly seen in men. The predominant causative agent is ultraviolet solar radiation exposure, with the majority of cases occurring on the head and neck. Surgical excision is typically the treatment of choice, providing histopathologic information, high cure rates, and acceptable cosmetic and functional outcomes. Radiation therapy is reserved for cases where surgery is not the preferred choice or for high-risk cases where adjuvant therapy is recommended. Although overall mortality rates are low, patients with complex cases such as those with immunosuppression should be considered for management within multidisciplinary tumor boards. In contrast, Merkel cell carcinoma is a rare and aggressive malignancy, frequently arising on the head and neck in older whites, with a poorer prognosis. This article focuses on the current evidence guiding practice, recent advances, and areas of controversy in NMSC and Merkel cell carcinoma of the head and neck.
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Affiliation(s)
- Sandro V Porceddu
- Sandro V. Porceddu, Princess Alexandra Hospital and University of Queensland, Brisbane, Queensland; Michael J. Veness, Westmead Cancer Cancer Centre; Michael J. Veness and Alexander Guminski, University of Sydney; and Alexander Guminski, Royal North Shore Hospital, Sydney, New South Wales, Australia.
| | - Michael J Veness
- Sandro V. Porceddu, Princess Alexandra Hospital and University of Queensland, Brisbane, Queensland; Michael J. Veness, Westmead Cancer Cancer Centre; Michael J. Veness and Alexander Guminski, University of Sydney; and Alexander Guminski, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Alexander Guminski
- Sandro V. Porceddu, Princess Alexandra Hospital and University of Queensland, Brisbane, Queensland; Michael J. Veness, Westmead Cancer Cancer Centre; Michael J. Veness and Alexander Guminski, University of Sydney; and Alexander Guminski, Royal North Shore Hospital, Sydney, New South Wales, Australia
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A case series and literature review of Merkel cell carcinoma metastasizing to pancreas. Dig Dis Sci 2015; 60:1805-12. [PMID: 25586085 DOI: 10.1007/s10620-014-3516-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 12/29/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Merkel cell carcinoma is a rare aggressive tumor arising from the mechanoreceptors of the epidermis with a relative higher mortality rate stage for stage than melanoma. Microscopically, the cells appear similar to small cell lung cancer, but they specifically stain positive for CK20 and are negative for TTF-1. It is rarely known to metastasize to the pancreas. AIMS To report four cases of Merkel cell carcinoma metastasizing to pancreas and compare them to previously reported patients. METHODS We performed a retrospective review of all patients who underwent endoscopic ultrasound with fine-needle aspiration (EUS-FNA) for a suspected pancreatic lesion between January 2004 and December 2012. We reviewed other reported cases with a literature search using PubMed, Embase, and Scopus. RESULTS Four male patients with mean age of 66 years were found to have metastatic disease in the pancreas on average 29 months after initial diagnosis of MCC. Two cases were diagnosed with EUS-FNA and two with PET-CT. Three patients had multifocal pancreatic involvement which has not been previously described. All four patients died within 3-9 months following tumor spread to the pancreas. Merkel cell carcinoma rarely metastasizes to the pancreas with only 10 cases being described in the medical literature. CONCLUSIONS EUS-FNA is an effective tool that can be utilized in diagnosing pancreatic masses. Differentiating metastatic pancreatic tumors, especially Merkel cell carcinoma from primary pancreatic tumor is useful as systemic therapy is an option in pancreatic adenocarcinoma, but is ineffective in metastatic Merkel cell carcinoma.
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Bloom R, Amber KT, Nouri K. An increased risk of non-Hodgkin lymphoma and chronic lymphocytic leukemia in US patients with Merkel cell carcinoma versus Australian patients: A clinical clue to a different mechanism of pathogenesis? Australas J Dermatol 2015; 57:e114-6. [PMID: 25801041 DOI: 10.1111/ajd.12325] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 02/12/2015] [Indexed: 01/23/2023]
Abstract
The US and Queensland populations both demonstrate an increased risk of secondary malignancies following the diagnosis of Merkel cell carcinoma (MCC). A recent Queensland study failed to demonstrate a significantly increased risk of developing non-Hodgkin lymphoma (NHL) or chronic lymphocytic leukaemia (CLL) in these patients. In contrast, using the US Surveillance, Epidemiology, and End Results database, we demonstrate there is an increased risk in CLL and NHL following the diagnosis of MCC in the USA. We hypothesise that this difference may be a result of a differing pathogenesis.
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Affiliation(s)
- Romi Bloom
- Department of Dermatology & Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Kyle T Amber
- Department of Medical Education, Macneal Hospital, Berwyn, Illinois, USA
| | - Keyvan Nouri
- Department of Dermatology & Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
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Merkel cell carcinoma in immunosuppressed patients. Cancers (Basel) 2014; 6:1328-50. [PMID: 24978436 PMCID: PMC4190543 DOI: 10.3390/cancers6031328] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 05/22/2014] [Accepted: 06/09/2014] [Indexed: 02/07/2023] Open
Abstract
Merkel cell carcinoma (MCC) is a rare and aggressive cutaneous malignancy. The infectivity of Merkel cell polyomavirus (MCPyV), an apparent agent in MCC development, may be exacerbated with impaired immune responses. This paper reviews relevant data regarding the role of immunosuppression in the development of MCC and describes modes of immunodeficient states. Because of the inherently low incidence rate of MCC, several case studies and series are also briefly mentioned to provide a more comprehensive summary of MCC in the setting of immunosuppression. We describe immunosuppressed patients who have experienced excessive UV radiation, organ transplantation, human immunodeficiency virus infection/AIDS, autoimmune diseases, and lymphoproliferative disorders. Iatrogenic forms of immunosuppression are also highlighted. Studies that quantify risks consistently report that individuals with a history of solid organ transplantation, autoimmune diseases, AIDS, and/or lymphoproliferative diseases have a significantly elevated risk of developing MCC. Overall, immunocompromised patients also appear to have an early onset and more aggressive course of MCC, with poorer outcomes. Recommendations for multidisciplinary approaches are proposed to effectively prevent and manage MCC in these patients.
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Merkel cell carcinoma - recent advances in the biology, diagnostics and treatment. Int J Biochem Cell Biol 2014; 53:536-46. [PMID: 24811434 DOI: 10.1016/j.biocel.2014.04.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 04/27/2014] [Accepted: 04/28/2014] [Indexed: 11/24/2022]
Abstract
Merkel cell carcinoma (MCC) is an uncommon primary cutaneous carcinoma with neuroendocrine differentiation. Since recent discovery of MCCs strong association with Merkel cell polyomavirus (MCPyV), there has been a rapid increase in the understanding of the carcinomas genetics, molecular biology and pathogenesis. In our study, we reviewed recent advances and controversies concerning MCC histogenesis, epidemiology, diagnostic and prognostic markers. We analyzed the association of MCPyV with MCC and the possible new targets for therapy. We also examined English-based literature regarding MCC pathogenesis published between 2008 and 2013, which lead to a deeper understanding of the topic. Our study showed that the association of MCPyV strongly influences the course of MCC. Additionally, it has been shown that a immunological response to MCPyV may in the future give hope to identify new therapeutic strategies in treatment of this fatal malignancy. This article is part of a Directed Issue entitled: Rare Cancers.
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Paradisi A, Abeni D. Clustering of cutaneous melanoma in health care workers of a dermatological day hospital unit. Dermatology 2014; 228:281-4. [PMID: 24603034 DOI: 10.1159/000356179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 10/06/2013] [Indexed: 12/16/2023] Open
Abstract
BACKGROUND The incidence of cutaneous melanoma is increasing but in most countries is still below 20/100,000 per year. Despite such a low frequency of occurrence, recently the authors have had notice of several new melanoma cases among colleagues. We carried out a survey of melanoma occurrence among the personnel, and their close relatives, of a dermatological clinic. The self-reported figures were compared with data from cancer registries. OBSERVATIONS Thirty-eight doctors and nurses were surveyed. Three responders reported having had a diagnosis of melanoma (7.9%, 95% CI 1.7-21.4%). The respondents reported having 617 'relatives who are alive today and would have come to them if they had a melanoma': 12 had known diagnoses of melanoma (1.9%, 95% CI 1.0-3.4%). The relative risks were 26.3 (95% CI 8.9-78.0) and 4.1 (95% CI 1.2-13.8) for doctors and nurses compared to the general population and to their relatives, respectively, and 6.5 (95% CI 3.7-11.4) for relatives compared to the general population. CONCLUSIONS Two nonmutually exclusive hypotheses may be formulated to explain these findings: (a) most cutaneous melanomas regress spontaneously; (b) an infectious agent is involved in the causal pathway of cutaneous melanoma. Further studies may be warranted to confirm our observations and test such hypotheses.
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Affiliation(s)
- Andrea Paradisi
- Health Services Research Unit, Istituto Dermopatico dell'Immacolata, IRCCS, Rome, Italy
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Abstract
I read the article “Complete spontaneous regression of Merkel cell carcinoma metastatic to the liver: Did lifestyle modifications and dietary supplements play a role?”1 with great interest. Merkel cell carcinoma carries a significant rate of recurrence and mortality.2 Though spontaneous regression of Merkel cell carcinoma has been well documented in the literature,3 the potential that the pathway of spontaneous regression functions via increased natural killer cell activation, second to ingestion of assorted mushrooms in this case, is promising for future research efforts. The Merkel cell polyomavirus (MCV) status of this patient is, however, extremely important in progressing the findings of this case report.
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Howle JR, Veness MJ. Outcome of Patients with Microscopic and Macroscopic Metastatic Nodal Merkel Cell Carcinoma: An Australian Experience. Dermatol Surg 2014; 40:46-51. [DOI: 10.1111/dsu.12390] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Comar M, Zanotta N, Del Savio R, Vascotto F, Calabrese N, Zorat F, Pozzato G. No evidence of Polyomavirus and EBV infections in Italian patients with mixed cryoglobulinemia infected chronically with HCV. J Med Virol 2013; 86:666-71. [DOI: 10.1002/jmv.23867] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2013] [Indexed: 12/31/2022]
Affiliation(s)
- Manola Comar
- Institute for Maternal and Child Health-IRCCS “Burlo Garofolo,”; Trieste Italy
- Department of Medical Sciences Clinical Unit of Hygiene; University of Trieste; Trieste Italy
| | - Nunzia Zanotta
- Institute for Maternal and Child Health-IRCCS “Burlo Garofolo,”; Trieste Italy
| | - Rossella Del Savio
- Institute for Maternal and Child Health-IRCCS “Burlo Garofolo,”; Trieste Italy
| | - Fulvia Vascotto
- Institute for Maternal and Child Health-IRCCS “Burlo Garofolo,”; Trieste Italy
| | - Nadia Calabrese
- Department of Medical Sciences Clinical Unit of Haematology; University of Trieste; Trieste Italy
| | - Francesca Zorat
- Department of Medical Sciences Clinical Unit of Haematology; University of Trieste; Trieste Italy
| | - Gabriele Pozzato
- Department of Medical Sciences Clinical Unit of Haematology; University of Trieste; Trieste Italy
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Iacovides D, Michael S, Achilleos C, Strati K. Shared mechanisms in stemness and carcinogenesis: lessons from oncogenic viruses. Front Cell Infect Microbiol 2013; 3:66. [PMID: 24400225 PMCID: PMC3872316 DOI: 10.3389/fcimb.2013.00066] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 12/03/2013] [Indexed: 01/08/2023] Open
Abstract
A rise in technologies for epigenetic reprogramming of cells to pluripotency, highlights the potential of understanding and manipulating cellular plasticity in unprecedented ways. Increasing evidence points to shared mechanisms between cellular reprogramming and the carcinogenic process, with the emerging possibility to harness these parallels in future therapeutics. In this review, we present a synopsis of recent work from oncogenic viruses which contributes to this body of knowledge, establishing a nexus between infection, cancer, and stemness.
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Affiliation(s)
| | - Stella Michael
- Department of Biological Sciences, University of Cyprus Nicosia, Cyprus
| | - Charis Achilleos
- Department of Biological Sciences, University of Cyprus Nicosia, Cyprus
| | - Katerina Strati
- Department of Biological Sciences, University of Cyprus Nicosia, Cyprus
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Sickmüller B, Thurisch B, Kaszkin-Bettag M. Proposal for Publishing and Parallel Reporting of Case Reports on Adverse Drug Reactions to Authorities by Physicians. Glob Adv Health Med 2013; 2:7. [PMID: 24416658 PMCID: PMC3833521 DOI: 10.7453/gahmj.2013.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
For the safe use of medicinal products, it is important that physicians publish adverse experiences with a medicinal product—particularly regarding side effects—in the scientific literature. However, when searching applicable publications, we determined that adverse drug reactions (ADRs) are often published several months after their occurrence. In the context of patient safety, this is rather questionable as new and important information on ADRs is not available quickly enough to be considered in pharmacovigilance systems. This delay is also not acceptable on the background of the timelines—eg, European Union (EU) legislation requires that marketing authorization holders (MAH) report serious ADRs (SADRs) within 15 calendar days. The legal basis for ADR reporting by physicians and other healthcare professionals is specified in article 102 of the EU Directive 2001/83/ EC as amended (2010/84/EU).
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Affiliation(s)
- Barbara Sickmüller
- Senior Scientific Advisor, German Pharmaceutical Industry Association/Bundesverband der Pharmazeutischen Industrie e. V (BPI), Berlin, Germany
| | - Boris Thurisch
- Head of Pharmacovigilance, German Pharmaceutical Industry Association/ Bundesverband der Pharmazeutischen Industrie e. V (BPI), Berlin, Germany
| | - Marietta Kaszkin-Bettag
- Head of Preclinical & Medical Affairs and Scientific Expert, PharmaLex GmbH, Mannheim, Germany
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Beer K. Commentary: Merkel cell carcinoma: bridging the gap. Dermatol Surg 2013; 39:239. [PMID: 23387357 DOI: 10.1111/dsu.12003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Kenneth Beer
- Beer Dermatology, University of Miami, West Palm Beach, Florida, USA.
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