Merkel Cell Carcinoma

Merkel cells are found in the top layer of the skin. These cells are very close to the nerve endings that receive the sensation of touch. Merkel cell carcinoma, also called neuroendocrine carcinoma of the skin or trabecular cancer, is a very rare type of skin cancer that forms when Merkel cells grow out of control. Merkel cell carcinoma starts most often in areas of skin exposed to the sun, especially the head and neck, as well as the arms, legs, and trunk of the body.

Learn more about the skin.

One Location for Coordinated Merkel Cell Carcinoma Care

Patients with Merkel cell carcinoma often require a combination of surgery, chemotherapy, and radiation therapy. Because of this, a team approach which can coordinate all care is the best way to manage these complicated cases.

At Brigham and Women’s Hospital (BWH), our surgical oncologists are among the world’s leading surgical specialists treating complex and advanced-stage Merkel cell carcinoma. They are the surgical team at the Center for Cutaneous Oncology at the Dana-Farber/Brigham and Women’s Cancer Center. Working together as one singularly-focused team, we help Merkel cell carcinoma patients get better faster with improved outcomes and fewer post-operative problems. From diagnosis to treatment, our multidisciplinary team of surgical oncologists, dermatologists, pathologists, medical oncologists, plastic and reconstructive surgeons and radiation oncologists work collaboratively with patients and families. 

  • The dermatopathologists at Dana-Farber/Brigham and Women’s Cancer Center are among the best in the world with special expertise in diagnosing rare cases. This is extremely important as the patient’s treatment plan is guided by the diagnosis. For the ten percent of cases that are not routine, this is especially relevant.
  • The BWH plastic and reconstructive surgeons are pioneers in ground-breaking procedures. The size and experience of our group allow us to tailor specific, individual care to each patient. 

In addition dedicated patient coordinators ensure that you understand your care plan and help you set up the appointments with various specialists.

Merkel Cell Carcinoma Surgical Specialist

Our board certified oncology surgeon Charles Yoon, PhD, MD, FACS is a specialist in treatment for advanced and complex Merkel cell carcinoma.

Merkel Cell Carcinoma Topics

Risk Factors for Merkel Cell Carcinoma

The known risk factors for Merkel cell carcinoma include:

  • Exposure to UV rays. The risk of Merkel cell carcinoma is higher in people who have been exposed to a lot of ultraviolet (UV) rays from the sun or from other sources like tanning beds. People who are treated for psoriasis with UV rays may also have a higher risk.
  • Weakened immune system. People with weakened immune systems, such as people who have had an organ transplant, are at increased risk for this cancer.
  • Light-colored skin. People with lighter skin are at higher risk.
  • Older age. People older than 50 are more likely to get this cancer.
  • Being male. Men are more likely to get Merkel cell carcinoma.

Researchers have found that Merkel cell carcinoma almost always shows infection with a virus known as Merkel cell polyomavirus (MCV). It is not known how the virus may contribute to the growth of this cancer. Most people are infected with this virus at some point, but very few people develop this cancer.

Learn more about risk factors for Merkel cell carcinoma.

Symptoms of Merkel Cell Carcinoma

Merkel cell carcinoma tumors are most often found on sun-exposed areas of skin, such as the face, neck, and arms but they can start anywhere on the body. They usually appear as firm, shiny skin lumps that do not hurt. The lumps may be red, pink, or blue. They tend to grow very quickly.

Learn more about symptoms of Merkel cell carcinoma.

Diagnosis of Merkel Cell Carcinoma

The diagnosis of Merkel cell carcinoma is done with a biopsy, a sample of tissue that’s taken to be tested in a lab. However, diagnosis of Merkel cell carcinoma can be difficult especially since it can look like many other types of cancer. The dermatopathologists at Dana-Farber/Brigham and Women’s Cancer Center are among the best in the world with special expertise in diagnosing rare cases such as Merkel cell carcinoma.

Early diagnosis and treatment of Merkel cell carcinoma is important to prevent the cancer from spreading. Be aware of any lumps, growths, moles, or other abnormal areas on your skin. Watch for new spots or areas that are changing. This can include skin marks that as grow larger, bleed, crust, or itch. Your health care provider may recommend you do a skin self-exam once a month or more.

See your health care provider if you have any new or changing marks on the skin.

Biopsy

Your health care provider will likely take a biopsy of any mole or other skin mark that may look like cancer.

The different types of biopsies include the following:

  • Excisional biopsy. Used when a wider or deeper piece of the skin is needed and when a melanoma is suspected. The entire mole and part of the surrounding skin is removed.
  • Incisional biopsy. This procedure is the same as an excisional biopsy. But only part of the mole or mark is removed.
  • Punch biopsy. This type uses a special tool to take a deep sample of skin. The tool removes a short cylinder of tissue, like an apple core.
  • Shave biopsy. This type of biopsy removes the top layers of skin shaved off with a scalpel.

Learn more about Merkel cell carcinoma diagnosis.

Stages of Merkel Cell Carcinoma

The process used to find out if cancer has spread to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.

Learn more about the staging of Merkel cell carcinoma.

Treatment Options for Merkel Cell Carcinoma

The surgical specialists at BWH along with their colleagues at the Dana-Farber/Brigham and Women’s Cancer Center have special expertise treating Merkel cell carcinoma.

Surgery

The following surgical procedures may be used to treat Merkel cell carcinoma:

  • Wide excision: The cancer is cut from the skin along with normal tissue surrounding the lesion. A sentinel lymph node biopsy may be done during the wide excision. If there is cancer in the lymph nodes, a lymph node dissection also may be done.
  • Lymph node dissection: A surgical procedure in which the lymph nodes are removed and a sample of tissue is checked under a microscope for signs of cancer. For a regional lymph node dissection, some of the lymph nodes in the tumor area are removed; for a radical lymph node dissection, most or all of the lymph nodes in the tumor area are removed. This procedure is also called lymphadenectomy.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy X-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).

What You Should Expect

You will receive a thorough diagnostic examination to evaluate your condition and determine what course of treatment is needed. Careful monitoring and the involvement by an experienced surgical oncologist is important to the successful outcome for patients with advanced or complex Merkel cell carcinoma.

If you are having surgery or a procedure, you will likely be scheduled for a visit to the Weiner Center for Preoperative Evaluation for pre-operative information and tests.

The day of surgery, you will be taken care of in the operating room by surgeons, anesthesiologists and nurses who specialize in surgery for patients with Merkel cell carcinoma. After surgery, you will recover in the post-surgical care unit where you will receive comprehensive care by an experienced surgical and nursing staff.

Learn more about your hospital stay and returning home.

Multidisciplinary Care

The surgical specialists at BWH along with their colleagues at the DF/BWCC Center for Cutaneous Oncology provide the world’s most advanced and innovative multidisciplinary care for patients with Merkel cell carcinoma. Our treatment team includes surgical oncologists, medical and radiation oncologists, plastic surgeons, nutritionists, pathologists and anesthesiologists. In addition, patients have full access to BWH’s world-renowned academic medical community with its diverse specialists and state-of-the-art facilities.

Resources

Learn more about Merkel cell carcinoma in our health library.

Visit the Kessler Health Education Library in the Bretholtz Center for Patients and Families to access computers and knowledgeable staff.

Visit the Weiner Center for Preoperative Evaluation.

Access a complete directory of patient and family services.

Care for the Caregiver offers tips for family and friends.

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