mantle cell carcinoma | Merkel cell carcinoma

Merkel cell carcinoma

Merkel's cell carcinoma is a rare type of skin cancer other than melanoma. It appears in the cells of Merkel, present in the deepest part of the upper layer, or outer, of the skin called epidermis, and in the hair follicles (small bags where the bristles originate). Merkel's cells are close to the nerves and help to provide the touch. They also produce hormones.

Merkel's cell carcinoma usually appears on skin surfaces exposed to the sun, especially the head, neck, arms and legs. It develops and spreads quickly, so it is aggressive.

Merkel's cell carcinoma is also referred to as cutaneous neuroendocrine carcinoma or trabecular carcinoma.

Signs and symptoms
Merkel's cell carcinoma is used to appear in the form of a firm, elevated mass on the skin. The mass can be red or violet and is usually not painful.

Since Merkel's cell carcinoma tends to grow and spread rapidly, new masses can form on the skin all around. Lymph nodes can become larger than normal, especially at the neck and armpit.

Diagnosis
The tests used to diagnose Merkel's cell carcinoma usually include a physical examination, a skin examination, and a skin biopsy of the mass. Skin biopsy is either a shaving biopsy, a punch biopsy, an incisional biopsy, or an excisional biopsy. If we diagnose Merkel's cell carcinoma, we could do additional tests, such as CT and MRI, to see if the cancer has spread to other parts of the body. We can also offer you a sentinel ganglion biopsy. This test can provide the doctor with information on how quickly the cancer develops and spreads and will help plan the treatment.

Learn more about these tests and the diagnosis of non-melanoma skin cancer.

Stages
The staging describes or classifies cancer according to the amount of cancer present in the body and its location during the initial diagnosis. This is often referred to as the extent of cancer. The information revealed by the tests is used to determine the size of the tumor, what parts of the skin are affected by cancer, whether the cancer has spread from its place of origin and where it has spread. Your healthcare team uses the stage to plan your treatment and anticipate the outcome (your prognosis).

The staging system used for Merkel's cell carcinoma is the TNM classification. In the case of Merkel's cell carcinoma, there are 5 stages, the stage 0 followed by stages 1 to 4. For stages 1 to 4, Roman numerals I, II, III and IV are often used. But in order to make the text clearer, we will use Arabic numerals 1, 2, 3 and 4. In general, the higher the number of the stage, the more the cancer has spread. Talk to your doctor if you have any questions about the staging.

Learn more about the staging of cancer.

Merkel's cell carcinoma is stadifieed differently from other skin cancers other than melanoma.

Stage 0 (carcinoma in situ)
The cancer is found only in the upper, or outer, layer of the skin (epidermis).

Stage One
Cancer measures 2 cm or less.

Stage 2a
Cancer measures more than 2 cm.

Stage 2b
Cancer may have spread to the bones, muscles, cartilages or fascias (connective tissue that envelops the surrounding muscles, nerves, blood vessels and organs).

Stage 3a
The cancer has spread to the surrounding lymph nodes.

Stadium 3b
Cancer areas are observed between the location where the cancer originated (primitive siege) and the nearest lymph nodes (metastasis in transit). It may also have spread to nearby lymph nodes.

Stage 4

Cancer has spread to other parts of the body (remote metastasis), such as tissues located under the skin or lymph nodes farther from the original location, lungs or liver. We're also talking about metastatic cancer.

Merkel's cell carcinoma recurrence

The recurrence of Merkel's cell carcinoma means that the cancer reappears as a result of the treatment. If he reappears at the place where he first started, we are talking about local recidivism. If it reappears in tissues or lymph nodes located near where it first originated, it is referred to as a regional recurrence. It can also reappear in another part of the body: we are talking about relapse or remote metastasis.

Treatment of Merkel's cell carcinoma

You may be offered one or more of the following treatments for Merkel's cell carcinoma. Your healthcare team will offer treatments based on the stage of the cancer and the place where it originated. We will talk with you to develop a treatment plan.

Surgery

The type of surgery performed depends on the stage (cancer size and location).

The wide local excision helps to remove the cancer as well as a little normal tissue all around, which is called surgical margin. This is the standard type of treatment when Merkel's cell carcinoma is found only in the skin and has not spread to other parts of the body.

Mohs surgery helps to remove cancer in layers, gradually, until there is no more. It can be used when the doctor wants to leave in place as much normal tissue as possible, so-called tissue preservation. We can perform Mohs surgery for a Merkel cell carcinoma in the face for example.

Lymph nodes that may contain cancer can be removed from the ganglion. It is used when the doctor can feel that the lymph nodes are swollen or that a sentinel ganglion biopsy reveals that the lymph node is cancerous. We can do the lymph node cleaning after removing the primitive tumor.

Radiotherapy

During the external radiation therapy, a device is used to direct a radiation beam to the cancer and some of the surrounding tissue.

Radiotherapy can be administered after surgery to destroy all remaining cancer cells and help reduce the risk of recurrence, or recidivism, of cancer (adjuvant treatment). Sometimes we direct radiation to the lymph nodes next to the tumor. It can also be used to treat a Merkel cell carcinoma that reappeared after surgery. Radiation therapy can also help relieve the symptoms of advanced stage Merkel cell carcinoma (palliative treatment).

Chemotherapy and other medications

In chemotherapy, medications are administered to treat Merkel's cell carcinoma. It is most often used to treat stage 4 Merkel cell carcinoma to help reduce its size, slow growth and spread, and relieve symptoms. It can be administered alone or with other treatments.

The chemotherapeutic agent most often administered to treat Merkel cell carcinoma is cisplatin (Platinol aq) or carboplatin (flattened, flattened aq), which can be associated with etoposide (Vepesid, VP-16). Only Topotecan (Hycamtin) may be used in some cases, as in the case of older adults. Chemotherapy is usually administered by a needle inserted into a vein (intravenous) every two or three weeks. The treatment continues as long as the cancer does not get bigger or spread further and you are able to tolerate the side effects.

Avélumab (Bavencio) is a monoclonal antibody used as a drug to treat metastatic Merkel cell carcinoma in adults who have already been treated. Avélumab helps immune system cells to attack and destroy cancer cells. It is administered by a needle inserted in a vein (infusion) at 2 weeks. Your doctor will determine how many treatment sessions are needed.

Clinical trials

You may be asked if you would like to participate in a clinical trial on skin cancer. Learn more about clinical trials