Merkel Cell Carcinoma | Symptoms, Diagnosis & Treatment | MedStar Health

Advanced care for rare skin cancers from an experienced team of specialists.

Merkel cell carcinoma is a rare type of skin cancer that can grow quickly and spread rapidly to lymph nodes and other parts of the body. Also called neuroendocrine carcinoma, this type of cancer typically develops on parts of the body that are regularly exposed to the sun, like the head, neck, arms, and legs, but not always. They can vary in color and may appear as a large, shiny bump, like a pimple.

Because this type of cancer can be aggressive, it's important to seek care early from a team of doctors with experience in this type of carcinoma treatment. The good news is that many times it's curable, especially if it's found early. At MedStar Health, our team of fellowship-trained surgical oncologists have decades of combined experience in caring for people with Merkel cell carcinoma and other cancers. If you notice something concerning, or you've been diagnosed with skin cancer, we offer second opinion consultations within 48 hours so you can get the answers you need quickly.

Here, we work as a multidisciplinary team to effectively diagnose and treat this type of carcinoma. Because your care involves input from several specialists who stay up-to-date in the latest research, you can be confident knowing you're receiving the most advanced treatment options. These may include cutting-edge clinical trials, which offer access to new therapies and drug combinations that could offer promising results for even the most advanced cancers. Through our partnership with Georgetown Lombardi Cancer Center, Washington, D.C.'s only National Cancer Institute-designated cancer center, our doctors continue investigating new and better ways to treat—and prevent—this cancer and others.

 

Symptoms and risk factors

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)

Screening and prevention

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.

 

Diagnosis

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.

Treatments

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 Targeted Therapy

Learn More About Immunotherapy

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

Looking for expert cancer care?

With multiple locations throughout the region, patients have access to many of the nation’s renowned cancer specialists offering high quality care, second opinions and a chance for better outcomes close to where they live and work. Georgetown Lombardi Comprehensive Cancer Center, one of the nation’s comprehensive cancer centers designated by the National Cancer Institute (NCI), serves as the research engine allowing patients access to clinical trials that often lead to breakthroughs in cancer care.

Our locations

Distance from Change locationEnter your location

MedStar Health: Dermatology at Chevy Chase

5530 Wisconsin Ave
The Chevy Chase Bldg.
Ste. 730
Chevy Chase, MD 20815

MedStar Health: Dermatology at Lafayette Centre

1133 21st St. NW
Building 2
8th Floor
Washington, D.C., 20036

MedStar Health: Dermatology at MedStar Georgetown University Hospital

3800 Reservoir Rd. NW
Pasquerilla Health Center
1st Floor
Washington, D.C., 20007

MedStar Health: Dermatology at MedStar Washington Hospital Center

110 Irving St. NW
Suite 1A50A
Washington, D.C., 20010

MedStar Health: Dermatology at Tenleytown

4200 Wisconsin Ave. NW
4th Floor
Washington, D.C., 20016

MedStar Health: Dermatology in Washington D.C.

106 Irving St. NW
Physician's Office Bldg. South
Ste. 410
Washington, D.C., 20010

Why choose us

Our collaborative team of specialists focus exclusively on treating common and very rare skin cancers. At MedStar Health, we treat a high number of patients with skin cancer every year, including uncommon ones like Merkel cell. Because we have decades of combined experience, we are better equipped to care for even the most complex cases. This expertise results in better experiences, outcomes, and quality of life for our patients with skin cancer.

We offer comprehensive skin cancer care under one roof, including those only available in state-of-the-art clinical trials. All of our specialists caring for patients at our academic medical centers and our community-based facilities are at the forefront of skin cancer care in their respective fields. Your personalized treatment plan will be based on the latest advances in detecting, managing, and treating Merkel cell carcinoma using surgery, chemotherapy, immunotherapy, radiation therapy, and reconstructive procedures, when appropriate. And because we're affiliated with the only comprehensive cancer center designated by the NCI based in Washington, D.C., you gain access to clinical trials that may be hard to find at other cancer centers.

You'll gain access to personalized support services and a compassionate team who can help you heal physically and emotionally. If you're diagnosed with skin cancer, you may feel overwhelmed. Here, your team is dedicated to helping you understand your options so you can feel confident in making decisions about your care. A nurse navigator is often your primary point of contact, giving you a direct line of communication to someone who can:

  • Answer any questions you have
  • Provide education to empower you
  • Connect you to the right specialty services
  • Assist with quickly scheduling tests, surgeries, and other appointments

Awards and recognition

Recipient of an Accreditation with Commendation, the highest level of approval, from the American College of Surgeons’ Commission on Cancer (CoC)

Numerous surgeons, medical oncologists, and surgical oncologists recognized as "Top Doctors" by both Baltimore Magazine and the Washingtonian

Magnet® designation from the American Nurses Credentialing Center (ANCC)

Clinical trials and research

Clinical trials

Clinical trials are research studies that test new drugs or approaches for detecting and treating diseases. These trials lead to safer, more effective ways for eliminating cancer and improving the quality of life for cancer survivors. We regularly lead and participate in clinical trials, including immunotherapy studies that offer promising results for many patients with skin cancer.

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Research

We are constantly looking for new ways to improve care for patients with Merkel cell carcinoma. Through our research engine, the Georgetown Lombardi Comprehensive Cancer Center, our doctors investigate and lead studies that find new treatments or treatment combinations that can help to manage and treat this rare cancer.

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Support services

The journey with cancer is not just a physical one. It's a disease that can affect every aspect of your life, which is why having a strong support system is critical to your care. At MedStar Health, we support you and your family through services and programs designed to help you deal with emotional stress, minimize side effects, and improve your health and wellness.

Learn More About Cancer Support Services

Genetic counseling

Although Merkel cell carcinomas don't seem to be hereditary, having one cancer can increase your risk of developing another. Our board-certified genetic counselors can help you understand you and your family's cancer risk and determine if you would benefit from genetic testing. And, they can recommend strategies to lower your risk and potentially prevent certain cancers altogether.

Learn More About Genetic Counseling

Personalized rehabilitation

As you navigate treatment and recovery, rehabilitation services can help you feel and move your best. Depending on your needs, you may benefit from specialty care that involves physical therapists, occupational therapists, physiatrists, neuropsychologists, and others who can help you to deal with side effects and maximize your strength, mobility, and cognitive abilities. We also have therapists specially-trained to manage painful swelling called lymphedema, which can be a side effect of lymph node removal.

Learn More About Cancer Rehabilitation

Survivorship

Following treatment, we offer a full range of programs designed to help you navigate any physical, emotional, or psychosocial concerns that arise. From help with managing late effects of cancer treatment and follow-up care to manage the risk of recurring skin cancer to counseling and other specialized services, we're here to help you thrive as a cancer survivor.

Learn More About the Cancer Survivorship Program