Merkel Cell Carcinoma

The most common warning sign is a shiny, painless nodule on the skin.

Many people with Merkel cell carcinoma seek care after noticing a small, shiny pimple-like bump that grows. Most commonly, this type of cancer grows on sun-exposed areas, like the face, neck, scalp, arms, and legs. However, it can also occur in places often hidden from the sun, such as in the abdomen or bottom.

It's important to remember that this cancer can look different for everyone. In general, you should talk to your primary care doctor or dermatologist if you notice a change to your skin, such as a lesion or bump that expands quickly over weeks or months.

Like other skin cancers, Merkel cell carcinoma is often caused by too much ultraviolet (UV) exposure.

This type of cancer develops more often in fair-skinned males than females, and most people who have it are over 50. Other factors that increase your risk of Merkel cell carcinomas include having:

• A history of excessive UV exposure from the sun or indoor tanning beds
• Weakened immune system due to certain diseases (like HIV or certain cancers) or immunosuppressant medications for various conditions (such as Crohn's disease or rheumatoid arthritis)

• A personal history of another skin cancer (such as melanoma, basal cell carcinoma, or squamous cell carcinoma)

Be vigilant about sun protection and skin checks.

Because this skin cancer is so closely linked to too much sun exposure, there are several things you can do to protect your skin and lower your risk. Everyone of all ages and skin types should:

• Wear a generous amount of broad-spectrum sunscreen with an SPF of 30 or higher anytime they're outside
• Cover their body with UPF-rated clothing and hats that shields skin from the sun
• Protect their eyes with sunglasses that offer UV light protection
• Examine their own skin regularly for anything that changes size, shape, or color

Early detection significantly improves Merkel cell carcinoma survival rates, so seek care as soon as you notice a bump, freckle, or mole that looks unusual. Even if it ends up being nothing, it's always better to know rather than to wait and risk it being something serious.

We use several methods for identifying and diagnosing this aggressive skin cancer.

This skin cancer can be challenging to diagnose which is why it's important to seek care at a place like MedStar Health, where we regularly diagnose and treat patients with Merkel cell carcinoma. If you have a suspicious bump, your dermatologist will perform a thorough examination that may include:

• Reviewing your medical history: We'll ask you about your medical history and whether you have ever had cancer or other serious illnesses.
• Conducting a physical examination: Your dermatologist will check to see if you have any unusual-looking bumps, freckles, moles, or other spots on the skin.
• Collecting a skin biopsy: We'll remove skin cells from the concerning area. A pathologist specializing in dermatology will then examine it under a microscope.

If we determine you have this type of skin cancer, we will refer you to a surgical oncologist who will also review your medical history and examine your skin. After reviewing your skin biopsy, they may recommend additional tests to determine the stage, or how far cancer has spread. These may include:

• Advanced imaging tests: A chest x-ray or CT scan may help us learn whether your cancer has spread (metastasized) to other parts of the body.
• Sentinel lymph node biopsy: As cancer spreads, it can metastasize through the lymphatic system (the nodes, tissues, and organs that produce and store infection-fighting white blood cells). The first lymph nodes the cancer cells come in contact with as they move from their tumor of origin are called sentinel lymph nodes. Sentinel lymph node biopsy is a low-risk surgery to identify, remove, and microscopically examine the lymph nodes directly in the pathway of spreading cancer cells. This way, only those lymph nodes that may be affected by abnormal cells are removed, increasing the potential to save lives while eliminating, in most cases, the need for a more complicated surgery.

Your treatment depends on the size, location, and stage of your cancer.

Although surgery is often the primary treatment for most patients who develop Merkel cell carcinoma, we work as a team to determine if and when you may benefit from other approaches. A surgical oncologist will guide your care, collaborating with dermatologists, pathologists, radiologists, medical oncologists, radiation oncologists, plastic surgeons, and others to ensure that we offer the most personalized, advanced cancer treatments based on your needs.

Depending on the extent and location of your cancer, your team of surgical oncologists will recommend any of the following treatment options.

Surgery

The best and most common first treatment is surgery to remove Merkel cell carcinoma tumors. During the procedure is called a wide local excision, your surgical oncologist will cut out the cancer, as well as a margin of healthy tissue surrounding it to ensure no cancer remains. Sometimes this is performed at the same time as a sentinel lymph node biopsy, which is used to see if cancer has spread to lymph nodes. If it has, patients may benefit from additional treatments.

Once the tumor is removed, your surgeon may work with plastic surgeons and other specialists to minimize scarring and/or close any wounds that are too large to close with stitches. Reconstructive procedures may involve skin flaps or grafts, leading to a more natural cosmetic outcome.

Follow-up care

Even though many of these skin cancers can be cured, the disease can recur in the same place. And, if you’ve been treated for skin cancer in the past, you have the increased risk of developing new cancer elsewhere on the skin. Because of the increased risk of recurrence, it's important for you to continue to perform regular skin cancer self-exams, visit your MedStar Health doctor for regular checkups, and follow your doctor's instructions on how to reduce the risk of developing skin cancer again.

Chemotherapy

This type of systemic therapy is used to treat Merkel cell carcinoma, but today, immunotherapy and other drugs are more effective in reducing the chances of this cancer returning. Your care team will include a medical oncologist who will determine which drugs will be most effective in treating your cancer and helping you to maintain the highest possible quality of life.

Learn More About Chemotherapy

Immunotherapy and targeted therapy

Immunotherapy drugs are some of the newest treatment options that may be used to treat metastatic Merkel cell carcinoma. This therapy uses the body's own immune system to fight cancer cells when cancer has spread to lymph nodes or other organs in the body. We pioneered many of these drugs in clinical trials, and we continue to investigate new treatments and combinations for managing this cancer using immunotherapy.

Learn More About Immunotherapy

Learn More About Targeted Therapy

Radiation therapy

Radiation therapy uses high-energy rays to kill cancer cells. Your doctor may use this treatment for cancers that occur in areas that are hard to treat with surgery, such as the eyelid, the tip of the nose, or the ear. In other cases, radiation therapy may be used after surgery to minimize the cancer's chances of coming back. If radiation therapy is part of your treatment, your radiation oncologist will determine the right dose and frequency based on the unique characteristics of your tumor.

Because we have access to all of the most advanced radiation technologies, we can more effectively target cancer while limiting radiation to as much healthy tissue as possible. Radiation therapy may cause a rash or make the skin in the area dry or red, and it's possible to notice changes in skin color and/or texture years after treatment is over. Your care team will help to proactively manage and monitor any side effects at weekly check-ins and throughout your recovery.

Learn More About Radiation Therapy