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Harvey JA, Mirza SA, Erwin PJ, Chan AW, Murad MH, Brewer JD. Recurrence and mortality rates with different treatment approaches of Merkel cell carcinoma: a systematic review and meta-analysis. Int J Dermatol 2021; 61:687-697. [PMID: 34227108 DOI: 10.1111/ijd.15753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 05/29/2021] [Accepted: 06/10/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Comprehensive treatment recommendations for Merkel cell carcinoma are complex. We aimed to systematically review the published data on recurrence and mortality rates associated with various treatment approaches for Merkel cell carcinoma. METHODS Search of MEDLINE, Embase, Web of Science, and Scopus from inception to August 2015. Studies were included that reported comparative survival and recurrence data for two or more treatment modalities. Two reviewers independently reviewed and abstracted recurrence and mortality rates. Event rates for individual treatment arms in each study were pooled and meta-analyzed across studies using a random-effects model. RESULTS Fifty-two retrospective studies met inclusion criteria, revealing a total of 1,804 patients with primary Merkel cell carcinoma with data available for analyses. The recurrence rate was higher for surgery alone (55.0%) versus a combination of surgery and radiotherapy (39.0%) (odds ratio, 2.089; 95% CI, 1.374-3.177; P < 0.001). Combination therapy including surgery, radiotherapy, and chemotherapy had a higher mortality rate (44.6%) than did combined surgery and radiotherapy (23.2%) (odds ratio, 2.688; 95% CI, 1.196-6.037; P = 0.02). CONCLUSIONS The treatment of Merkel cell carcinoma with surgery plus adjuvant radiotherapy may produce lower recurrence rates.
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Affiliation(s)
| | - Sultan A Mirza
- Mayo Clinic Health System - Southwest Minnesota Region, Mankato, MN, USA
| | | | - An W Chan
- Department of Dermatology & Mohs Surgery, Women's College Hospital, Toronto, Ontario, Canada
| | - M H Murad
- Division of Preventive, Occupational and Aerospace Medicine and the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
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2
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Viruses and Skin Cancer. Int J Mol Sci 2021; 22:ijms22105399. [PMID: 34065594 PMCID: PMC8161099 DOI: 10.3390/ijms22105399] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 12/11/2022] Open
Abstract
Advances in virology and skin cancer over recent decades have produced achievements that have been recognized not only in the field of dermatology, but also in other areas of medicine. They have modified the therapeutic and preventive solutions that can be offered to some patients and represent a significant step forward in our knowledge of the biology of skin cancer. In this paper, we review the viral agents responsible for different types of skin cancer, especially for solid skin tumors. We focus on human papillomavirus and squamous cell cancers, Merkel cell polyomavirus and Merkel cell carcinoma, and human herpesvirus 8 and Kaposi’s sarcoma.
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3
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Farah M, Reuben A, Spassova I, Yang RK, Kubat L, Nagarajan P, Ning J, Li W, Aung PP, Curry JL, Torres-Cabala CA, Hudgens CW, Ugurel S, Schadendorf D, Gumbs C, Little LD, Futreal A, Wistuba II, Prieto VG, Wang L, Wong MK, Wargo JA, Becker JC, Tetzlaff MT. T-Cell Repertoire in Combination with T-Cell Density Predicts Clinical Outcomes in Patients with Merkel Cell Carcinoma. J Invest Dermatol 2020; 140:2146-2156.e4. [PMID: 32304704 DOI: 10.1016/j.jid.2020.02.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 02/09/2020] [Accepted: 02/12/2020] [Indexed: 02/03/2023]
Abstract
The integrity of the immune system represents a pivotal risk factor and prognostic biomarker for Merkel cell carcinoma. A higher density of tumor-associated T cells correlates with improved Merkel cell carcinoma-specific survival, but the prognostic importance of the T-cell infiltrate reactivity is unknown. We evaluated the T-cell receptor repertoire associated with 72 primary Merkel cell carcinomas and correlated metrics of the T-cell receptor repertoire with clinicopathologic characteristics and patient outcomes. We showed that a high Simpson's Dominance index (SDom) was significantly associated with fewer metastases (P = 0.01), lower stage at presentation (P = 0.02), lower final stage at last follow-up (P = 0.05), and longer time to first lymph node metastasis (P = 0.04). These correlations were mostly preserved in the Merkel cell polyomavirus-negative subgroup. Combining SDom with CD3+ or CD8+ T-cell density revealed three distinct prognostic groups with respect to disease-specific survival. Patients with both high SDom and high CD3+ or CD8+ T-cell density had markedly improved disease-specific survival compared with patients with low SDom and low CD3+ or CD8+ T-cell density (P = 0.002 and P = 0.03, respectively). Patients with either high SDom or high CD3+ or CD8+ had intermediate disease-specific survival. Our findings demonstrate that the quality of the tumor-associated T-cell infiltrate informs patient prognosis in primary Merkel cell carcinoma beyond the T-cell density.
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Affiliation(s)
- Maya Farah
- Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alexandre Reuben
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ivelina Spassova
- Translational Skin Cancer Research, University Clinic Essen, Essen, Germany
| | - Richard K Yang
- Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Linda Kubat
- Translational Skin Cancer Research, University Clinic Essen, Essen, Germany
| | - Priyadharsini Nagarajan
- Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jing Ning
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Wen Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Phyu P Aung
- Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jonathan L Curry
- Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Carlos A Torres-Cabala
- Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Courtney W Hudgens
- Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Selma Ugurel
- Department of Dermatology, University Clinic Essen, Essen, Germany
| | - Dirk Schadendorf
- Department of Dermatology, University Clinic Essen, Essen, Germany
| | - Curtis Gumbs
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Latasha D Little
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Andrew Futreal
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ignacio I Wistuba
- Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Victor G Prieto
- Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Linghua Wang
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael K Wong
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jennifer A Wargo
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jürgen C Becker
- Translational Skin Cancer Research, University Clinic Essen, Essen, Germany; Department of Dermatology, University Clinic Essen, Essen, Germany; German Cancer Consortium, German Cancer Center, Heidelberg, Germany
| | - Michael T Tetzlaff
- Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
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4
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Principe DR, Clark JI, Emami B, Borowicz S. Combined radio-immunotherapy leads to complete clinical regression of stage IV Merkel cell carcinoma. BMJ Case Rep 2019; 12:12/8/e230518. [PMID: 31439556 DOI: 10.1136/bcr-2019-230518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine tumour of the skin. While localised disease carries an overall favourable prognosis, metastatic disease is associated with poor clincal outcomes. Most cases of metastatic MCC are managed with systemic chemotherapy or immunotherapy, though 5-year survival for these patients remains a dismal 17%. Here, we present the case of a 79-year-old man with MCC of the right ear with metastases to regional lymph nodes, ipsilateral parotid gland and thoracic spine. He was treated with a combination of first-line radiotherapy and concurrent immune checkpoint inhibition (avelumab), which led to complete clinical regression of disease with minimal adverse effects. This observation suggests that combined radio-immunotherapy warrants larger-scale investigation for use in patients with unresectable MCC.
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Affiliation(s)
- Daniel R Principe
- Medical Scientist Training Program, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Joseph I Clark
- Division of Hematology-Oncology, Department of Medicine, Cardinal Bernardin Cancer Center, Loyola University Medical Center, Hines, Illinois, USA.,Medical Service, Edward Hines, Jr. Hines VA Hospital, Hines, Illinois, USA
| | - Bahman Emami
- Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Loyola University Medical Center, Hines, Illinois, USA
| | - Stanley Borowicz
- Division of Hematology-Oncology, Department of Medicine, Cardinal Bernardin Cancer Center, Loyola University Medical Center, Hines, Illinois, USA.,Medical Service, Edward Hines, Jr. Hines VA Hospital, Hines, Illinois, USA
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5
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Ollier J, Kervarrec T, Samimi M, Benlalam H, Aumont P, Vivien R, Touzé A, Labarrière N, Vié H, Clémenceau B. Merkel cell carcinoma and cellular cytotoxicity: sensitivity to cellular lysis and screening for potential target antigens suitable for antibody-dependent cellular cytotoxicity. Cancer Immunol Immunother 2018; 67:1209-1219. [PMID: 29808366 PMCID: PMC11028380 DOI: 10.1007/s00262-018-2176-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 05/22/2018] [Indexed: 12/26/2022]
Abstract
The recent success of checkpoint inhibitors in the treatment of Merkel cell carcinoma (MCC) confirms that MCC tumors can be immunogenic. However, no treatment directly targeting the tumor is available for use in combination with these checkpoint inhibitors to enhance their efficacity. This study was carried out to characterize MCC line sensitivity to cellular lysis and to identify cell surface antigens that could be used for direct targeting of this tumor. For five representative MCC lines, the absence or low expression of MICA, MICB, HLA-I, and ICAM-1 was associated with low level of recognition by NK cells and T lymphocytes. However, expression of HLA-I and ICAM-1 and sensitivity to cellular lysis could be restored or increased after exposure to INFγ. We tested 41 antibodies specific for 41 different antigens using a novel antibody-dependent cellular cytotoxicity (ADCC) screening system for target antigens. Anti-CD326 (EpCAM) was the only antibody capable of inducing ADCC on the five MCC lines tested. Because MCC tumors are often directly accessible, local pharmacologic manipulation to restore HLA class-I and ICAM-1 cell surface expression (and thus sensitivity to cell lysis) can potentially benefit immune therapeutic intervention. In line with this, our observation that ADCC against EpCAM can induce lysis of MCC lines and suggests that therapeutic targeting of this antigen deserves to be explored further.
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Affiliation(s)
- Jocelyn Ollier
- Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCINA), Institut National de la Santé et de la Recherche Médicale (INSERM U1232), Centre national de la recherche scientifique (CNRS), Université d'Angers, Université de Nantes, 8 Quai Moncousu, 44007, Nantes Cedex, France
- Laboratoire d'Excellence Immunotherapy, Graft, Oncology (LabEx IGO), 44000, Nantes, France
| | - Thibault Kervarrec
- Department of Pathology, Centre Hospitalier Universitaire (CHU) de Tours, Université Francois Rabelais, avenue de la République, 37170, Chambray-les-tours, France
- Université François Rabelais, Unité Mixte de Recherche Institut National de la Recherche Agronomique Infectiologie Santé Publique (UMR INRA ISP) 1282, 31 avenue Monge, 37200, Tours, France
| | - Mahtab Samimi
- Department of Dermatology, Centre Hospitalier Universitaire (CHU) de Tours, Université François Rabelais, avenue de la République, 37170, Chambray-les-tours, France
- Université François Rabelais, Unité Mixte de Recherche Institut National de la Recherche Agronomique Infectiologie Santé Publique (UMR INRA ISP) 1282, 31 avenue Monge, 37200, Tours, France
| | - Houssem Benlalam
- Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCINA), Institut National de la Santé et de la Recherche Médicale (INSERM U1232), Centre national de la recherche scientifique (CNRS), Université d'Angers, Université de Nantes, 8 Quai Moncousu, 44007, Nantes Cedex, France
| | - Pascal Aumont
- Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCINA), Institut National de la Santé et de la Recherche Médicale (INSERM U1232), Centre national de la recherche scientifique (CNRS), Université d'Angers, Université de Nantes, 8 Quai Moncousu, 44007, Nantes Cedex, France
| | - Régine Vivien
- Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCINA), Institut National de la Santé et de la Recherche Médicale (INSERM U1232), Centre national de la recherche scientifique (CNRS), Université d'Angers, Université de Nantes, 8 Quai Moncousu, 44007, Nantes Cedex, France
- Laboratoire d'Excellence Immunotherapy, Graft, Oncology (LabEx IGO), 44000, Nantes, France
| | - Antoine Touzé
- Université François Rabelais, Unité Mixte de Recherche Institut National de la Recherche Agronomique Infectiologie Santé Publique (UMR INRA ISP) 1282, 31 avenue Monge, 37200, Tours, France
| | - Nathalie Labarrière
- Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCINA), Institut National de la Santé et de la Recherche Médicale (INSERM U1232), Centre national de la recherche scientifique (CNRS), Université d'Angers, Université de Nantes, 8 Quai Moncousu, 44007, Nantes Cedex, France
- Centre Hospitalier Universitaire (CHU) de Nantes, Hôtel Dieu, Unité de Thérapie Cellulaire et Génique, 44093, Nantes, France
- Laboratoire d'Excellence Immunotherapy, Graft, Oncology (LabEx IGO), 44000, Nantes, France
| | - Henri Vié
- Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCINA), Institut National de la Santé et de la Recherche Médicale (INSERM U1232), Centre national de la recherche scientifique (CNRS), Université d'Angers, Université de Nantes, 8 Quai Moncousu, 44007, Nantes Cedex, France.
- Etablissement Français du Sang (EFS), Pays de la Loire, site de Nantes, 44000, Nantes, France.
- Laboratoire d'Excellence Immunotherapy, Graft, Oncology (LabEx IGO), 44000, Nantes, France.
| | - Béatrice Clémenceau
- Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCINA), Institut National de la Santé et de la Recherche Médicale (INSERM U1232), Centre national de la recherche scientifique (CNRS), Université d'Angers, Université de Nantes, 8 Quai Moncousu, 44007, Nantes Cedex, France
- Centre Hospitalier Universitaire (CHU) de Nantes, Hôtel Dieu, Unité de Thérapie Cellulaire et Génique, 44093, Nantes, France
- Laboratoire d'Excellence Immunotherapy, Graft, Oncology (LabEx IGO), 44000, Nantes, France
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6
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Al-Rohil RN, Milton DR, Nagarajan P, Curry JL, Feldmeyer L, Torres-Cabala CA, Ivan D, Prieto VG, Tetzlaff MT, Aung PP. Intratumoral and peritumoral lymphovascular invasion detected by D2-40 immunohistochemistry correlates with metastasis in primary cutaneous Merkel cell carcinoma. Hum Pathol 2018; 77:98-107. [PMID: 29601841 DOI: 10.1016/j.humpath.2018.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/12/2018] [Accepted: 03/19/2018] [Indexed: 12/21/2022]
Abstract
Primary cutaneous Merkel cell carcinoma (MCC) is an aggressive neuroendocrine malignancy in which lymphovascular invasion (LVI) correlates with more aggressive phenotype. The prognostic significance of LVI detected by D2-40 immunohistochemistry (IHC) in MCC remains controversial. We aimed to determine how LVI detected by D2-40 IHC compares with LVI detected by hematoxylin and eosin (H&E) staining in predicting MCC metastasis. Clinical and histopathologic features of MCCs diagnosed and treated in 2002 to 2015 were assembled and included 58 MCC tumors from 58 patients. H&E-stained tissue sections and D2-40 IHC studies were reviewed. When LVI was present, the location (peritumoral or intratumoral) and the size of the largest invaded vessel were recorded. LVI findings by H&E staining and D2-40 IHC were compared with each other and with histologic features and clinical outcomes. H&E staining showed LVI in 37 of 58 cases; D2-40 IHC confirmed LVI in 30 of these cases but failed to confirm LVI in 7. D2-40 IHC also detected 14 cases of LVI not identified on H&E staining. Histologically, D2-40-detected LVI was associated with infiltrative growth pattern and nonbrisk lymphoid infiltrate (P = .005 and P = .055, respectively). There was a statistically significant difference between the frequency of detection of peritumoral LVI by H&E in comparison to D2-40 IHC (P = .0009). MCCs in which D2-40 IHC-detected both intratumoral and peritumoral LVI were typically larger than MCCs without (mean, 24.5 mm versus 17.3 mm; P = .03) and more frequently metastasized (87% versus 51%; P = .03). D2-40 IHC detection of both intratumoral and peritumoral LVI is associated with metastasis.
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Affiliation(s)
- Rami N Al-Rohil
- Department of Pathology, Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Denái R Milton
- Department of Biostatistics, Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Priyadharsini Nagarajan
- Department of Pathology, Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jonathan L Curry
- Department of Pathology, Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; Department of Dermatology, Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Laurence Feldmeyer
- Department of Pathology, Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Carlos A Torres-Cabala
- Department of Pathology, Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; Department of Dermatology, Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Doina Ivan
- Department of Pathology, Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; Department of Dermatology, Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Victor G Prieto
- Department of Pathology, Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; Department of Dermatology, Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Michael T Tetzlaff
- Department of Pathology, Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Phyu P Aung
- Department of Pathology, Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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7
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Abstract
Merkel cell carcinoma (MCC) is an aggressive cutaneous neuroendocrine carcinoma. Incidence of MCC continues to rise, and risk factors include advanced age, pale skin, chronic sun exposure, and immune suppression. Diagnosing MCC utilizes a combination of morphology and immunohistochemistry. Merkel cell polyomavirus (MCPyV) is present in approximately 70-80% of MCCs and represents a key pathogenic driver in those MCCs. In contrast, MCPyV-negative MCCs arise through progressive accumulation of ultraviolet-light induced somatic mutations. Staging of MCC proceeds according to the American Joint Commission on Cancer (AJCC) 8th Edition, which utilizes features of the primary tumor together with regional lymph node(s) (clinically and/or pathologically detected) and/or distant metastases. Many potentially useful biomarkers have been studied to refine risk stratification in MCC. In recent years, the host immune infiltrate has been leveraged as immune checkpoint blockade has emerged as an efficacious mode of treatment for patients with advanced MCC.
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Affiliation(s)
- Michael T. Tetzlaff
- 0000 0001 2291 4776grid.240145.6Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 85, Houston, TX 77030 USA ,0000 0001 2291 4776grid.240145.6Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 85, Houston, TX 77030 USA
| | - Priyadharsini Nagarajan
- 0000 0001 2291 4776grid.240145.6Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 85, Houston, TX 77030 USA
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8
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Catalano O, Alfageme Roldán F, Scotto di Santolo M, Solivetti FM, Wortsman X. Color Doppler Sonography of Merkel Cell Carcinoma. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:285-292. [PMID: 28726278 DOI: 10.1002/jum.14329] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 04/11/2017] [Accepted: 04/13/2017] [Indexed: 06/07/2023]
Abstract
We illustrate the color Doppler sonographic findings in primary cutaneous Merkel cell carcinoma. Eight cases (4 female and 4 male; mean age, 75.4 years) were collected. The most common affected regions were the face (63%) and the hip/buttock (25%). The mean transverse diameter and thickness were 21 and 14 mm, respectively. Fifty percent were oval, and 50% were dome shaped. All lesions were hypoechoic, with variable degrees of heterogeneity. All but 2 lesions were poorly defined. An acoustic reinforcement artifact was present in 3 and epidermal thickening in 2. All tumors had prominent and chaotic hypervascularity with arterial vessels (mean peak velocity, 11 cm/s; mean resistive index, 0.57).
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Affiliation(s)
- Orlando Catalano
- Department of Radiology, National Cancer Institute, Pascale Foundation, Naples, Italy
| | | | | | | | - Ximena Wortsman
- Institute for Diagnostic Imaging of the Skin and Soft Tissues, Santiago, Chile (X.W.); Department of Imaging, Clinica Servet, Santiago, Chile (X.W.); and Department of Dermatology, Faculty of Medicine, University of Chile, Santiago, Chile
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9
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Update on Merkel Cell Carcinoma: Epidemiology, Etiopathogenesis, Clinical Features, Diagnosis, and Staging. ACTAS DERMO-SIFILIOGRAFICAS 2017. [DOI: 10.1016/j.adengl.2016.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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10
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Llombart B, Requena C, Cruz J. Update on Merkel Cell Carcinoma: Epidemiology, Etiopathogenesis, Clinical Features, Diagnosis, and Staging. ACTAS DERMO-SIFILIOGRAFICAS 2016; 108:108-119. [PMID: 27770997 DOI: 10.1016/j.ad.2016.07.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 07/01/2016] [Accepted: 07/29/2016] [Indexed: 10/20/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare, highly aggressive tumor, and local or regional disease recurrence is common, as is metastasis. MCC usually develops in sun-exposed skin in patients of advanced age. Its incidence has risen 4-fold in recent decades as the population has aged and immunohistochemical techniques have led to more diagnoses. The pathogenesis of MCC remains unclear but UV radiation, immunosuppression, and the presence of Merkel cell polyomavirus in the tumor genome seem to play key roles. This review seeks to update our understanding of the epidemiology, etiology, pathogenesis, and clinical features of MCC. We also review histologic and immunohistochemical features required for diagnosis. MCC staging is discussed, given its great importance in establishing a prognosis for these patients.
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Affiliation(s)
- B Llombart
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España.
| | - C Requena
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - J Cruz
- Servicio de Anatomía Patológica, Instituto Valenciano de Oncología, Valencia, España
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11
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Feldmeyer L, Hudgens CW, Ray-Lyons G, Nagarajan P, Aung PP, Curry JL, Torres-Cabala CA, Mino B, Rodriguez-Canales J, Reuben A, Chen PL, Ko JS, Billings SD, Bassett RL, Wistuba II, Cooper ZA, Prieto VG, Wargo JA, Tetzlaff MT. Density, Distribution, and Composition of Immune Infiltrates Correlate with Survival in Merkel Cell Carcinoma. Clin Cancer Res 2016; 22:5553-5563. [PMID: 27166398 DOI: 10.1158/1078-0432.ccr-16-0392] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 05/04/2016] [Accepted: 05/05/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE Merkel cell carcinoma (MCC) is an aggressive cancer with frequent metastasis and death with few effective therapies. Because programmed death ligand-1 (PD-L1) is frequently expressed in MCC, immune checkpoint blockade has been leveraged as treatment for metastatic disease. There is therefore a critical need to understand the relationships between MCPyV status, immune profiles, and patient outcomes. EXPERIMENTAL DESIGN IHC for CD3, CD8, PD-1, PD-L1, and MCPyV T-antigen (to determine MCPyV status) was performed on 62 primary MCCs with annotated clinical outcomes. Automated image analysis quantified immune cell density (positive cells/mm2) at discrete geographic locations (tumor periphery, center, and hotspot). T-cell receptor sequencing (TCRseq) was performed in a subset of MCCs. RESULTS No histopathologic variable associated with overall survival (OS) or disease-specific survival (DSS), whereas higher CD3+ (P = 0.004) and CD8+ (P = 0.037) T-cell density at the tumor periphery associated with improved OS. Higher CD8+ T-cell density at the tumor periphery associated with improved DSS (P = 0.049). Stratifying MCCs according to MCPyV status, higher CD3+ (P = 0.026) and CD8+ (P = 0.015) T-cell density at the tumor periphery associated with improved OS for MCPyV+ but not MCPyV- MCC. TCRseq revealed clonal overlap among MCPyV+ samples, suggesting an antigen-specific response against a unifying antigen. CONCLUSIONS These findings establish the tumor-associated immune infiltrate at the tumor periphery as a robust prognostic indicator in MCC and provide a mechanistic rationale to further examine whether the immune infiltrate at the tumor periphery is relevant as a biomarker for response in ongoing and future checkpoint inhibitor trials in MCC. Clin Cancer Res; 22(22); 5553-63. ©2016 AACR.
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Affiliation(s)
- Laurence Feldmeyer
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Courtney W Hudgens
- Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Genevieve Ray-Lyons
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Phyu P Aung
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jonathan L Curry
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Carlos A Torres-Cabala
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Barbara Mino
- Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jaime Rodriguez-Canales
- Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alexandre Reuben
- Department of Surgical Oncology The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Pei-Ling Chen
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Surgical Oncology The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jennifer S Ko
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | | | - Roland L Bassett
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ignacio I Wistuba
- Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Zachary A Cooper
- Department of Surgical Oncology The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Victor G Prieto
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jennifer A Wargo
- Department of Surgical Oncology The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael T Tetzlaff
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas. .,Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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12
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Cardoso JC, Teixeira V, Tchernev G, Wollina U. Merkel cell carcinoma: a review and update on aetiopathogenesis, diagnosis and treatment approaches. Wien Med Wochenschr 2014; 163:359-67. [PMID: 23797682 DOI: 10.1007/s10354-013-0218-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 05/24/2013] [Indexed: 01/28/2023]
Abstract
Merkel cell carcinoma (MCC) or primary cutaneous neuroendocrine carcinoma is a relatively uncommon form of skin cancer. It is an aggressive neoplasm with high tendency for local recurrence and lymph node and distant metastasis, whose incidence has been rising in the last 2 decades.A novel polyomavirus (MCPyV) has been found in a significant proportion of MCCs, and this finding significantly contributed to the understanding of its pathogenesis.It is fairly consensual at the current state of know-ledge that appropriate staging, including sentinel lymph node biopsy, is very important in order to plan adequate treatment. Treatment includes aggressive surgery of the primary tumour and lymph node basin, commonly combined with adjuvant radiotherapy. Chemotherapy is usually reserved for distant metastasis.In the present article, the authors review the current knowledge about MCC with special emphasis on the new pathogenetic findings and current recommendations regarding management.
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13
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Soltani AM, Allan BJ, Best MJ, Panthaki ZJ, Thaller SR. Merkel cell carcinoma of the hand and upper extremity: current trends and outcomes. J Plast Reconstr Aesthet Surg 2013; 67:e71-7. [PMID: 24125874 DOI: 10.1016/j.bjps.2013.09.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 07/17/2013] [Accepted: 09/23/2013] [Indexed: 01/29/2023]
Abstract
Merkel cell carcinomas represent an uncommon yet aggressive skin cancer. We sought to identify changes in incidence and predictors of outcomes and survival of patients with Merkel cell carcinomas of the hand and upper extremity. The Surveillance, Epidemiology and End Results database was used to identify all patients with Merkel cell carcinomas of the skin located specifically in the hand and upper extremity. Overall, 5211 cases were identified in the period from 1986 through 2009. The age-adjusted incidence of Merkel cell carcinoma of the hand and upper extremity increased from 0.02 cases per 100,000 in 1986 to 0.14 cases per 100,000 in 2009. The mean age of these patients was 75 years and positive regional lymph nodes were identified in 33%. Rate of metastasis was 4.1%. Overall survival for the study cohort was 49%. Multivariate analysis identified tumor size >5 cm, positive regional lymph nodes and metastasis at diagnosis as independent predictors of mortality. The incidence of Merkel cell carcinomas has increased substantially over the study period. Overall survival for Merkel cell carcinomas of the body and hand and upper extremity is related to tumor size and extent of disease at time of clinical presentation. Merkel cell carcinomas of the hand and upper extremity tend to be diagnosed at an earlier stage with lower rates of regional and systemic spread, and subsequently have a higher overall survival rate.
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Affiliation(s)
- Ali M Soltani
- Department of Surgery, Division of Plastic, Aesthetic, and Reconstructive Surgery, University of Miami, Miller School of Medicine, USA.
| | - Bassan J Allan
- Department of Surgery, Division of Plastic, Aesthetic, and Reconstructive Surgery, University of Miami, Miller School of Medicine, USA
| | - Matthew J Best
- Department of Surgery, Division of Plastic, Aesthetic, and Reconstructive Surgery, University of Miami, Miller School of Medicine, USA
| | - Zubin J Panthaki
- Department of Surgery, Division of Plastic, Aesthetic, and Reconstructive Surgery, University of Miami, Miller School of Medicine, USA
| | - Seth R Thaller
- Department of Surgery, Division of Plastic, Aesthetic, and Reconstructive Surgery, University of Miami, Miller School of Medicine, USA
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14
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Abstract
Merkel cell carcinoma (MCC) is a rare, clinically aggressive cutaneous neuroendocrine neoplasm with a high mortality rate. Though the etiology is not precisely known, Merkel cell polyomavirus DNA has been found recently in a large percentage of MCC tumors. Other suggested risk factors include sun exposure, immunosuppression, and a history of prior malignancy. Work up of patients with MCC most notably includes nodal staging via clinical examination or sentinel lymph node biopsy. The prognosis for most patients with MCC is poor, and the rarity of MCC precludes the prospective, randomized clinical trials necessary to elucidate optimum treatment protocols. Most published data support the use of a multimodality approach centered around surgical excision with negative margins, sentinel lymph node biopsy to establish the presence or absence of nodal metastases, adjuvant radiothearpy to decrease the risk of recurrence, and systemic chemotherapy in the case of widespread disease.
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15
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Coursaget P, Samimi M, Nicol JTJ, Gardair C, Touzé A. Human Merkel cell polyomavirus: virological background and clinical implications. APMIS 2013; 121:755-69. [PMID: 23781869 DOI: 10.1111/apm.12122] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 04/11/2013] [Indexed: 11/27/2022]
Abstract
The Merkel cell polyomavirus (MCPyV), identified in humans in 2008, is associated with a relatively rare but aggressive neuroendocrine skin cancer, the Merkel cell carcinoma (MCC). MCC incidence is increasing due to the advancing age of the population, the increase in damaging sun exposure and in the number of immunocompromised individuals. MCPyV must be considered as the etiological agent of MCC and thus is the first example of a human oncogenic polyomavirus. MCPyV infection is common, and seroprevalence studies indicate that widespread exposure begins early in life. The majority of adults have anti-MCPyV antibodies and there is a growing body of evidence that healthy human skin harbors resident or transient MCPyV suggesting that MCPyV infection persists throughout life. However, the mode of transmission, the host cells, and the latency characteristics of this virus remain to be elucidated. In addition, it is still not clear whether MCPyV is associated with diseases or lesions other than Merkel cell carcinoma. The etiologic role of MCPyV in MCC opens up opportunities to improve the understanding of this cancer and to potentially improve its treatment.
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16
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Sattler E, Geimer T, Sick I, Flaig MJ, Ruzicka T, Berking C, Kunte C. Sentinel lymph node in Merkel cell carcinoma: To biopsy or not to biopsy? J Dermatol 2013; 40:374-9. [DOI: 10.1111/1346-8138.12072] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Accepted: 11/21/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Elke Sattler
- Department of Dermatology and Allergology; Ludwig-Maximilian University of Munich; Munich; Germany
| | - Till Geimer
- Department of Dermatology and Allergology; Ludwig-Maximilian University of Munich; Munich; Germany
| | - Isabell Sick
- Department of Dermatology and Allergology; Ludwig-Maximilian University of Munich; Munich; Germany
| | - Michael J. Flaig
- Department of Dermatology and Allergology; Ludwig-Maximilian University of Munich; Munich; Germany
| | - Thomas Ruzicka
- Department of Dermatology and Allergology; Ludwig-Maximilian University of Munich; Munich; Germany
| | - Carola Berking
- Department of Dermatology and Allergology; Ludwig-Maximilian University of Munich; Munich; Germany
| | - Christian Kunte
- Department of Dermatology and Allergology; Ludwig-Maximilian University of Munich; Munich; Germany
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17
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Kouzmina M, Leikola J, Böhling T, Koljonen V. Positive sentinel lymph node biopsy predicts local metastases during the course of disease in Merkel cell carcinoma. J Plast Surg Hand Surg 2013; 47:139-43. [DOI: 10.3109/2000656x.2012.736386] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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18
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Samimi M, Touzé A, Laude H, Le Bidre E, Arnold F, Carpentier A, Gardair C, Carlotti A, Maubec E, Dupin N, Aubin F, Avril MF, Rozenberg F, Avenel-Audran M, Guyetant S, Lorette G, Machet L, Coursaget P. Vitamin D deficiency is associated with greater tumor size and poorer outcome in Merkel cell carcinoma patients. J Eur Acad Dermatol Venereol 2013; 28:298-308. [PMID: 23368852 DOI: 10.1111/jdv.12101] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 12/20/2012] [Indexed: 12/31/2022]
Abstract
BACKGROUND Merkel cell polyomavirus has been recognized to be associated with Merkel cell carcinoma (MCC), but the evolution of this cancer probably depends on various factors. Vitamin D deficiency, defined by serum 25-hydroxyvitamin D levels <50 nmol/L, seems to influence cancer behavior and progression, but has never been assessed in MCC patients. OBJECTIVES First, to evaluate whether vitamin D deficiency was associated with tumor characteristics and prognosis in a cohort of MCC patients. Second, to assess expression of the vitamin D receptor (VDR) in MCC tumors. METHODS Clinical findings, Merkel cell polyomavirus markers and vitamin D status were assessed in a cohort of French MCC patients. The study was limited to the 89 patients for whom the serum sample had been collected within 3 years after the diagnosis of MCC. Correlation between vitamin D deficiency and MCC characteristics and outcome were determined in regression analyses. VDR expression in MCC tumours was assessed by immunohistochemistry. RESULTS Vitamin D deficiency was noted in 65.1% of the patients and was independently associated with greater tumor size at diagnosis (P = 0.006) and with metastasis recurrence (HR, 2.89; 95% CI, 1.03 to 8.13; P = 0.043), but not with death from MCC, although there was a trend (HR, 5.28; 95% CI, 0.75 to 36.96; P = 0.093). VDR was found to be strongly expressed in all 28 MCC tumor specimens investigated. CONCLUSION The association between vitamin D deficiency and MCC characteristics and outcome, together with detection of the VDR in MCC cells, suggest that vitamin D could influence the biology of MCC.
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Affiliation(s)
- M Samimi
- INRA ISP, UMR 1282, Tours, France; Université François Rabelais, Tours, France; CHRU de Tours, Service de Dermatologie, Tours, France
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19
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Santamaria-Barria JA, Boland GM, Yeap BY, Nardi V, Dias-Santagata D, Cusack JC. Merkel cell carcinoma: 30-year experience from a single institution. Ann Surg Oncol 2012. [PMID: 23208132 DOI: 10.1245/s10434-012-2779-3] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a rare cutaneous malignancy. Few single-institution series have been reported. METHODS Review of MCC patients treated at our institution between 1980 and 2010. Patient, tumor, and treatment variables were analyzed to determine MCC-specific outcomes. RESULTS We identified 161 patients with MCC. There was a 2.5-fold increase in cases over the last decade. Median length of follow-up was 36 months. Stage at diagnosis was I in 35 %, II in 21 %, IIIa in 12 %, IIIb in 23 %, and IV in 9 %. The 5-year MCC-specific survival rates were 87, 63, 42, and 0 % for stages I, II, III, and IV, respectively. Death from the disease occurred in 10 % of patients with T1 and in 50 % with larger lesions. One-third of patients presented with nodal disease. Sentinel lymph node biopsy (SLNB) identified micrometastases in 9 out of 27 (33 %) early-stage patients. Recurrence developed in 56 % of SLNB-positive and 39 % of SLNB-negative patients. Half of patients recurred after a median time of 9 months. Proportions of first recurrence location were distant (52 %), nodal (27 %), and local (21 %). Adjuvant treatments did not improve recurrence or survival rates. One-third of patients died of the disease. CONCLUSIONS SLNB identifies micrometastasis in one-third of early-stage patients. Negative SLNB may predict for improved but not necessarily favorable outcome. Initial tumor size and clinical nodal disease predict for poor outcome. High recurrence rates warrant the development of more effective adjuvant therapies, and better markers of recurrence and treatment response for MCC are needed.
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Affiliation(s)
- Juan A Santamaria-Barria
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, YAW 7B, 55 Fruit Street, Boston, MA 02114, USA
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20
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Tarantola TI, Vallow LA, Halyard MY, Weenig RH, Warschaw KE, Grotz TE, Jakub JW, Roenigk RK, Brewer JD, Weaver AL, Otley CC. Prognostic factors in Merkel cell carcinoma: analysis of 240 cases. J Am Acad Dermatol 2012. [PMID: 23200197 DOI: 10.1016/j.jaad.2012.09.036] [Citation(s) in RCA: 122] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Knowledge regarding behavior of and prognostic factors for Merkel cell carcinoma (MCC) is limited. OBJECTIVE We sought to further understand the characteristics, behavior, prognostic factors, and optimal treatment of MCC. METHODS A multicenter, retrospective, consecutive study of patients with known primary MCC was completed. Overall survival and survival free of locoregional recurrence were calculated and statistical analysis of characteristics and outcomes was performed. RESULTS Among the 240 patients, the mean age at diagnosis was 70.1 years, 168 (70.0%) were male, and the majority was Caucasian. The most common location was head and neck (111, 46.3%). Immunosuppressed patients had significantly worse survival, with an overall 3-year survival of 43.4% compared with 68.1% in immunocompetent patients. In our study, patients with stage II disease had improved overall survival versus those with stage I disease, in a statistically significant manner. Patients with stage III disease had significantly worse survival compared with stage I and with stage II. Primary tumor size did not predict nodal involvement. CONCLUSION The data presented represent one of the largest series of primary MCC in the literature and confirm that MCC of all sizes has metastatic potential, supporting sentinel lymph node biopsy for all primary MCC. Because of the unpredictable natural history of MCC, we recommend individualization of care based on the details of each patient's tumor and clinical presentation.
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Affiliation(s)
- Tina I Tarantola
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA.
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21
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Hall BJ, Pincus LB, Yu SS, Oh DH, Wilson AR, McCalmont TH. Immunohistochemical prognostication of Merkel cell carcinoma: p63 expression but not polyomavirus status correlates with outcome. J Cutan Pathol 2012; 39:911-7. [PMID: 22882157 DOI: 10.1111/j.1600-0560.2012.01964.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 06/06/2012] [Accepted: 06/20/2012] [Indexed: 01/26/2023]
Abstract
Merkel cell carcinoma (MCC) represents a cutaneous malignancy with high associated mortality. Numerous studies have attempted to define characteristics to more accurately predict outcome. Two recent studies have demonstrated that Merkel cell polyomavirus (MCPyV) seropositivity correlated with a better prognosis, while a third study revealed no difference. Expression of p63 by tumor cell nuclei has been shown to be associated with a worse prognosis in a European cohort. To better understand the relationship between prognosis and MCPyV or p63 status, we used immunohistochemistry to evaluate both attributes in 36 US patients with MCC. Our results show that when considered as a binary variable, p63 expression represents a strong risk factor (p < 0.0001, hazards ratio (HR) = ∞) for shortened survival. In addition, our results show that MCPyV status does not correlate with survival (p = 0.6067, HR = 1.27). Our study corroborates the European observation that p63 immunoexpression is useful as a prognostic tool. Larger studies will need to be performed in order to determine whether p63 status should be included in MCC staging, since our study is limited by its relative small size.
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Affiliation(s)
- Brian J Hall
- Department of Pathology, University of Utah, Salt Lake City, UT, USA
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22
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Lim CS, Whalley D, Haydu LE, Murali R, Tippett J, Thompson JF, Hruby G, Scolyer RA. Increasing tumor thickness is associated with recurrence and poorer survival in patients with Merkel cell carcinoma. Ann Surg Oncol 2012; 19:3325-34. [PMID: 22820936 DOI: 10.1245/s10434-012-2509-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a rare, aggressive cutaneous neuroendocrine tumor usually occurring on sun-exposed skin in elderly patients. Clinical and pathologic factors associated with disease progression and mortality in patients with MCC are poorly defined. Recently, it has been reported that p63 expression in primary MCC is strongly associated with clinical outcome. METHODS MCC patients diagnosed between July 1, 1993 and July 31, 2009 were identified from the surgical pathology records of the Sydney South West Area Health Service. Clinical, pathologic, treatment, and survival data were obtained and immunohistochemical analyses for p53, p63, and Ki-67 were performed. The associations of clinical and pathologic features with disease-free and disease-specific survival were analyzed. RESULTS Ninety-five patients were identified (67 males, 28 females; median age at diagnosis of primary MCC 76 [range, 42-93] years). Increasing primary tumor thickness was significantly associated with poorer disease-free survival (5-year survival 18 % in tumors >10 mm thick compared with 69 % for patients with tumors ≤10 mm thick, p = 0.002) and disease-specific survival (5-year survival 74 % in tumors >10 mm thick compared with 97 % for patients with tumors ≤10 mm thick, p = 0.006). There was a strong positive correlation between the Ki-67 index (proportion of Ki-67-positive tumor nuclei) and tumor thickness (r = 0.39, n = 45, p = 0.008). Positive staining for p63 in MCC was infrequent (9 % of primary MCC) and showed no significant association with disease outcome. CONCLUSIONS Tumor thickness is significantly associated with disease-free survival in MCC. We recommend that primary tumor thickness be routinely recorded in the pathology reports of patients with primary MCC.
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Affiliation(s)
- Cathy S Lim
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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23
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Winer IS, Lonardo F, Johnson SC, Deppe G. Merkel cell carcinoma in a patient with noninvasive vulvar Paget's disease. Am J Obstet Gynecol 2012; 207:e9-11. [PMID: 22503648 DOI: 10.1016/j.ajog.2012.03.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 03/21/2012] [Accepted: 03/26/2012] [Indexed: 12/30/2022]
Abstract
We present the first case of inguinal Merkel cell carcinoma of unknown primary origin in a patient with vulvar Paget's disease. Correlation with immune suppression of both entities warrants further investigation. Additionally, this case highlights the value of ultrasound scanning in the detection of inguinal metastasis.
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Affiliation(s)
- Ira S Winer
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Wayne State University, Detroit, MI, USA.
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24
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Nicolaidou E, Mikrova A, Antoniou C, Katsambas AD. Advances in Merkel cell carcinoma pathogenesis and management: a recently discovered virus, a new international consensus staging system and new diagnostic codes. Br J Dermatol 2011; 166:16-21. [PMID: 21824123 DOI: 10.1111/j.1365-2133.2011.10562.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Merkel cell carcinoma is a rare but aggressive neuroendocrine carcinoma of the skin with a rising incidence and a high mortality rate. It occurs primarily in sun-exposed skin of older individuals. It is characterized by a high rate of local recurrence, regional lymph node metastases and distant metastases, occurring even after prompt treatment. Many controversies exist regarding its pathogenesis and optimal management. The discovery of Merkel cell polyomavirus has been a major breakthrough in understanding the aetiology of the disease. A recently adopted new international consensus staging system in combination with new international diagnostic codes are expected to facilitate future clinical trials and improve the management of patients. According to recent (2010) guidelines, most patients should be managed with a combination of surgery and radiotherapy.
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Affiliation(s)
- E Nicolaidou
- 1st Department of Dermatology and Venereology, University of Athens School of Medicine, Andreas Sygros Hospital, Athens, Greece.
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25
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Howle JR, Hughes TM, Gebski V, Veness MJ. Merkel cell carcinoma: an Australian perspective and the importance of addressing the regional lymph nodes in clinically node-negative patients. J Am Acad Dermatol 2011; 67:33-40. [PMID: 21996296 DOI: 10.1016/j.jaad.2011.07.029] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2010] [Revised: 06/26/2011] [Accepted: 07/08/2011] [Indexed: 01/17/2023]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a rare, aggressive cutaneous malignancy. Nodal status has prognostic significance. OBJECTIVE We sought to analyze for factors predictive of survival and explore the significance of lymph node status and indication for sentinel lymph node biopsy in patients with MCC. METHODS A review was undertaken of 136 patients presenting with MCC at our institution between 1980 and 2008. Patient and tumor characteristics, treatment, and patterns of relapse were analyzed. RESULTS Ninety patients presented with stage I disease, and 46 presented with stage II disease. The median follow-up time was 21 months. In all, 74 patients developed relapse with the commonest site of relapse in the regional lymph nodes. A total of 24 patients developed nodal relapse without prior treatment of the nodal basin. The 5-year survival was 62% and the median disease-free interval was 16 months. Radiotherapy was associated with a better disease-free survival (P < .001) and overall survival was worse as the number of involved lymph nodes increased (P = .03). LIMITATIONS This was a retrospective review with a prolonged accrual time. CONCLUSION A high rate of nodal relapse occurred in patients with stage I disease who had undergone treatment of the primary site only. These patients may have benefited from sentinel lymph node biopsy and subsequent treatment of the nodal basin if micrometastatic disease was present, as the number of involved nodes impacted negatively on survival. Conversely, sentinel lymph node biopsy may be used to select those patients with clinical stage I disease who may avoid elective nodal treatment. Radiotherapy should have a routine role in the management of MCC.
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Affiliation(s)
- Julie R Howle
- Head and Neck Cancer Service, Westmead Hospital, Sydney, Australia.
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26
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Chen L, Zhu L, Wu J, Lin T, Sun B, He Y. Giant Merkel cell carcinoma of the eyelid: a case report and review of the literature. World J Surg Oncol 2011; 9:58. [PMID: 21609425 PMCID: PMC3118133 DOI: 10.1186/1477-7819-9-58] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 05/24/2011] [Indexed: 11/22/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare cutaneous tumor and cases located in the eyelid have been described, but still its rarity may lead to difficulty in diagnosis and delay in treatment. A 51-year-old female patient that presented with large lesions in the eyelid underwent surgery after the diagnosis of acute chalazion. Following respiratory distress secondary to pulmonary metastasis, the patient's condition deteriorated and was not fit for complete excision treatment. Histopathological investigation of the biopsies, taken from the tumor, revealed that it was undifferentiated small cell carcinoma. Our aim with this paper is to point out that more cases should be reported for more effective diagnosis, histopathological study, clinical investigation, treatment and prognosis of this specific neoplasm.
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Affiliation(s)
- Luxia Chen
- TianJin Medical University Eye Center, 300084 TianJin, PR China.
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Gambichler T, Kobus S, Kreuter A, Wieland U, Stücker M. Primary merkel cell carcinoma clinically presenting as deep oedematous mass of the groin. Eur J Med Res 2010; 15:274-6. [PMID: 20696637 PMCID: PMC3351997 DOI: 10.1186/2047-783x-15-6-274] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a relatively rare, polyomavirus associated, primary neuroendocrine carcinoma of the skin which is usually arising from dermal skin layers. However, the origin of MCC in the subcutaneous tissue is debatable. We report a 58-yearold female patient with an oedematous mass on her left groin that was firm in consistency and had no discoloration or other visible abnormality of the overlying skin. On histology and immunohistology the tumour was consistent with the diagnosis of MCC showing a predominant subcutanous growth pattern. Pelvic magnetic resonance tomography revealed a tumour conglomerate reaching from the subcutis of the left groin to the left paraaortal and parailiacal region indicating widespread lymphogenic metastisation. Despite complete medical work-up no other MCC primary could be detected. In conclusion, predominant subcutaneous growth pattern as well as tumour localization in the groin are uncommon features of MCC. MCC showing the aforementioned features may be associated with significant delay of diagnosis and therefore represents an unfavourable prognostic factor.
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Affiliation(s)
- T Gambichler
- Department of Dermatology, Ruhr-University Bochum, Bochum, Germany.
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Handschel J, Müller D, Depprich RA, Ommerborn MA, Kübler NR, Naujoks C, Reifenberger J, Schäfer KL, Braunstein S. The new polyomavirus (MCPyV) does not affect the clinical course in MCCs. Int J Oral Maxillofac Surg 2010; 39:1086-90. [PMID: 20678899 DOI: 10.1016/j.ijom.2010.06.024] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Accepted: 06/09/2010] [Indexed: 10/19/2022]
Abstract
Since 2008, a new polyomavirus (MCPyV) in Merkel cell carcinomas (MCC) has been described, but little is known about its impact on the clinical course. The purpose of this study was to determine the presence of MCPyV in a large sample and to correlate the results with the clinical course of the disease. 59 samples from 44 patients were analysed for the presence of MCPyV using the primers LT3, VP1 and LT1. The clinical records of these patients were evaluated and correlated with the presence of MCPyV. 58% of specimens were positive for MCPyV. Of these, LT3 was positive in 53%, VP1 in 37% and LT1 in 10%. 57% of primary tumours and 53% of metastases were positive for LT3; the numbers for VP1 and LT1 were lower. There was no correlation between the detection of MCPyV in the primary tumour and the appearance of metastases. The survival time was statistically independent from the presence of MCPyV. There is a striking occurrence of MCPyV in MCC, but whether it affects the clinical course remains unclear.
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Affiliation(s)
- J Handschel
- Department for Cranio- and Maxillofacial Surgery, Heinrich-Heine-University, Düsseldorf, Germany.
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Unusually young Merkel cell carcinoma patients are Merkel cell polyomavirus positive and frequently immunocompromised. EUROPEAN JOURNAL OF PLASTIC SURGERY 2010. [DOI: 10.1007/s00238-010-0429-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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