Merkel Cell Carcinoma | Symptoms & Risk Factors | MedStar Health

Merkel cells make up one of the skin’s top layers. Merkel Cell Carcinoma is a rare type of cancer that affects these skin cells. It generally affects parts of the skin exposed to the sun, including the limbs, head, and neck.

We offer the expertise and compassionate care you need to manage Merkel cell carcinoma.

All of the surgical oncologists on our team have years of specialized training and experience treating Merkel cell carcinoma. We take a multidisciplinary approach to your care, collaborating with specialists in many fields to find the best solutions for you. Our care is driven by the latest research advances, and offers you access to the most advanced cancer clinical trials.

Risk factors

Risk factors make it more likely that you will develop a disease. The risk factors for Merkel Cell Carcinoma include:

  • Heavy exposure to sunlight

  • Heavy exposure to artificial light, including tanning beds

  • Diseases that affect your immune system, like HIV

  • Taking medication that suppresses your immune system


The symptoms of Merkel Cell Carcinoma may be similar to the symptoms for other problems. Make sure to talk with a doctor if you notice a lump that:

  • Appears on parts of the skin exposed to the sun, such as the head, neck, arms, and legs

  • Does not hurt

  • Grows quickly

  • Is red or purplish


Merkel Cell Carcinoma treatment requires the most experienced doctors and the most advanced therapy options. Our fellowship-trained surgical and medical oncologists at MedStar Health offer you the highest level of expertise and care available in our area.

Our team collaborates with a multidisciplinary group of experts to develop the most effective treatment options. We also use the most cutting-edge research and cancer clinical trials to manage your care. Plus, we specialize in giving second opinions to people who have received a diagnosis elsewhere.

We treat all of our patients with the MedStar Health spirit of cura personalis, or care for the whole person. We spend time with you and your family to develop a treatment plan tailored to your needs. Most importantly, we offer all of our patients compassion, kindness and respect.

Treatment Options

We offer a full range of effective treatments for Merkel Cell Carcinoma. Early-stage Merkel Cell Carcinomas are generally treated with surgery called a wide local excision. Other approaches may be considered. Given the high risk of spread for even early-stage tumors, sentinel lymph node biopsy with lymphatic mapping (lymphoscintigraphy) before surgery is frequently recommended.

Our expert doctors provide several types of treatment options:

  • Wide Local Excision: Excision is our standard approach, removing the cancer and up to two centimeters of surrounding tissue. 

  • Mohs Micrographic Surgery: During Mohs surgery, the cancer is shaved off one thin layer at a time and checked under a microscope. Such a procedure is helpful when the tumor:

    • Has an unknown shape and depth 

    • Is large 

    • Has returned

    • Is located in a hard-to-treat spot, especially in the head and neck

  • Sentinel lymph node biopsy with lymphatic mapping (lymphoscintigraphy) before surgery. During this minimally invasive procedure, the doctor injects a dye and a (safe) radioactive substance at the site of the cancer, then watches to see which lymph node it migrates to first—the sentinel lymph node. The lymph node is biopsied; if found clear, no further action is required. If it is not found clear, one or more lymph nodes may need to be removed—a surgery called dissection or lymphadenectomy. Patients with spread of their Merkel Cell Carcinoma to lymph nodes are generally offered imaging studies to stage their disease and radiation and drug therapy to reduce the risk of recurrence. Learn more about specialized skin cancer procedures.

Reconstruction and Grafting

Sometimes Merkel Cell Carcinoma is located in a cosmetically sensitive area, or the doctor had to remove a large amount of tissue. If that’s the case, your dermatologic oncologist will partner with one of our expert plastic surgeons when the surgery is still in the planning stage.

After the surgery, the plastic surgeon repairs any visible scars. For larger tumors, the surgical site is reconstructed with a skin graft, taken from a discreet place elsewhere on your body. The team works hard to ensure you are happy with the final results.

Radiation for Merkel Cell Carcinoma

Our experienced radiation oncologists partner with our dermatologic oncologists to deliver the latest radiation therapy — high-energy rays or special radioactive sources that damage cancer cells and stop them from growing.

  • External Beam Radiation Therapy: External beam radiation uses a large machine to aim high-energy radiation beams at your cancer from outside your body. Our specialists treat as small an area as possible to avoid causing unnecessary damage to your healthy tissue.

  • High-Dose Rate (HDR) Brachytherapy: This is a method of brachytherapy that delivers radiation to the lesion at the surface of the skin. In HDR brachytherapy, a radioactive wire is attached to a highly specialized robotic machine. The robotic machine carefully guides the delivery of the radiation directly into the tumor and removes the wire after the session.

  • Total Skin Electron Therapy: Rotational Total Skin Electron Therapy (RTSEI) and static Total Skin Electron Irradiation (TSEI) are advanced approaches to treating this skin disorder. During TSEI, a patient's entire skin is treated with low-energy electrons. This radiation penetrates very superficially, protecting internal organs and other structures.

  • Proton Beam Therapy

Merkel Cell Carcinoma can respond well to radiation therapy, and we may recommend it when: 

  • You’ve had surgery for Merkel Cell Carcinoma and it is offered to lower the risk of recurrence. 

  • The cancer is located in a place that’s hard to treat with surgery, such as the eyelids, tip of the nose or ears. 

  • The cancer was not responsive to drug therapy and involves limited areas. 

  • The cancer has spread to high risk areas such as the brain.

Immunotherapy for Merkel Cell Carcinoma

Immunotherapy represents a new and highly effective way to treat Merkel Cell Carcinoma.

Immunotherapies work to stimulate immune responses directed against the tumor cells to clear the cancer. Newer immunotherapy strategies target specific checkpoints in the immune system, which activate T-cells or reinvigorate exhausted T-cells to eliminate tumors. The main class of therapy is called immune checkpoint inhibitors (ICI), which include antibody therapy that blocks PD-1 and PD-L1 on immune cells and tumor cells. Anti-PD-1 and anti-PD-L1 therapies can produce durable responses in patients with active Merkel Cell Carcinoma. Many responding patients can eventually be monitored off active treatment. Additionally, anti-PD-1 and anti-PD-L1 immunotherapies are being studied in clinical trials as a way to prevent recurrence of Merkel Cell Carcinoma after surgery. While these therapies generally are well tolerated, auto-immune type side effects can occur. These can require prompt management by experienced providers.

While many patients with advanced Merkel Cell Carcinoma will have a durable response with anti-PD-1 and anti-PD-L1 therapies, not every patient responds to these therapies and alternative options are needed. New immunotherapy strategies are currently being explored in clinical trials at this time.


Merkel Cell Carcinoma is often responsive to chemotherapy, but the response may not be durable. Immunotherapy is usually a better choice when the disease is advanced. But chemotherapy can help relieve symptoms or extend survival for some patients and may be a good option in patients whose cancer progress on immunotherapy.

Follow-Up Care

Your physician will want to see you every three to six months following your treatment if there are no signs of active cancer. You may need to repeat any of the diagnostic tests to make sure the cancer is not returning.

Merkel Cell Carcinoma can return after treatment. To protect yourself from a recurrence, you should:

  • Stay out of the sun, especially during the hottest hours of the day

  • Always protect your body from the sun with hats, long sleeves, sunglasses and sunscreen

  • Regularly check your skin for new or changing moles or other marks

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