Merkel Cell Carcinoma – Diagnosis and Treatment
Diagnosis
Skin Check and Exam
A healthcare provider carefully checks the skin for any lumps, new spots, or changes in moles or freckles. They often use special tools and strong lighting to get a close look at areas that might be affected.
The provider checks not just the main tumor but also the surrounding skin and lymph nodes for swelling or abnormal growths.
Sometimes, the provider gently presses on nearby lymph nodes to feel for any unusual firmness or enlargement. These checks help spot suspicious growths that could be Merkel cell carcinoma.
Taking a Tissue Sample
A dermatologist or trained provider collects skin samples to confirm the diagnosis. They might use different methods to remove a small piece of skin or the entire lesion. Common biopsy techniques include:
- Punch Biopsy: A circular tool removes a core of skin tissue.
- Shave Biopsy: The provider shaves off a thin layer from the surface of the lesion.
- Excisional Biopsy: The provider cuts out the whole tumor and some nearby skin.
- Fine Needle Aspiration: A thin needle collects cells from a tumor or lymph node.
After removal, the tissue goes to a lab. Experts look for cancer cells, neuroendocrine features, or markers linked to Merkel cell polyomavirus with special stains or tests like immunohistochemistry. These steps confirm if the tumor is Merkel cell carcinoma.
Finding Out If It Has Spread
To check if the cancer has moved beyond the skin, providers use several tests:
- Sentinel lymph node biopsy helps find out if cancer is in the lymph nodes. A dye is injected near the tumor; then, the first lymph nodes that absorb the dye (sentinel nodes) are removed and tested for cancer cells.
- Imaging scans like PET, CT, and chest X-rays show tumors in other parts of the body. These pictures help doctors with cancer staging and checking if the cancer is only in the skin or has spread to organs or deeper lymph nodes.
In some cases, providers may order blood tests or other lab tests to check for changes in the immune system or signs of metastatic Merkel cell cancer.
Treatment
Surgical Methods
Surgeons widely use surgical methods to take out Merkel cell carcinoma. They remove not only the cancer itself but also some healthy skin around it to lower the risk of the cancer coming back.
This edge of healthy skin is often called a margin. If the cancer has spread to nearby lymph nodes, the surgeon can remove those, too. This process is known as a lymph node dissection.
In some cases, a special approach named Mohs surgery is chosen. With Mohs, the doctor cuts away thin layers of skin one at a time and checks each right away under a microscope for cancer cells.
The doctor keeps removing layers until no cancer is found, leaving as much healthy skin as possible.
| Surgery Types | Key Information |
|---|---|
| Wide Excision | Removes tumor and margin of healthy skin |
| Mohs Surgery | Removes one skin layer at a time and checks each |
| Lymph Node Removal | Removes affected lymph nodes |
Focused Beam Therapy
Focused beam therapy, also known as radiation, uses high-powered energy waves to attack cancer cells. Providers often start radiation after surgery to target any microscopic cancer cells left behind.
Radiation might also be the only option for people who are not good candidates for surgery. For those whose cancer has spread to other locations, radiation can help manage the disease or slow metastasis.
Some use radiation therapy to shrink tumors before operating or to ease symptoms caused by advanced Merkel cell carcinoma.
Medicines that Help the Immune System
Immunotherapy medicines, which help the immune system, are a newer choice for treating Merkel cell carcinoma. These medicines boost the bodyโs natural defenses to recognize and attack cancer cells.
Providers can offer immunotherapy if cancer comes back, if it spreads, or if other treatments do not work well. Doctors may choose immunotherapy drugs, like immune checkpoint inhibitors, for advanced disease.
Treatment with Anti-Cancer Drugs
Anti-cancer drugs, also called chemotherapy, attack rapidly growing cells throughout the body.
While not the first treatment for Merkel cell carcinoma, doctors might suggest chemotherapy if the cancer spreads to lymph nodes, other organs, or returns after earlier treatments.
Doctors carefully weigh the risks and benefits of chemotherapy since side effects can be strong and results may not last long for everyone. It remains an option for difficult or advanced cases of Merkel cell carcinoma.
Getting Ready for Your Visit
Steps You Can Take
Bring someone you trust to your appointment. This person can take notes or remind you of important details. If you are older or have other health conditions, you might want extra support during your visit.
Create a Checklist
Write down the following before seeing your doctor:
- Current symptoms, when they started, and any changes, even if they seem unrelated.
- Personal background, including major stressors, life events, and any family history of serious medical conditions.
- All medications you use, such as prescriptions, over-the-counter pills, vitamins, or supplements. Include how much you take of each.
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Health questions that are important to you. You can ask about:
- The possible causes of your symptoms.
- Recommended tests or procedures.
- Treatment options and outcomes.
- How to handle other health problems together with this condition.
Use this table to make your list:
| Category | Examples |
|---|---|
| Symptoms | Red bump, skin change, itching, swelling |
| Personal History | Recent stress, race, age, major life changes |
| Medical Info | HIV, immune issues, other cancers, gender |
| Sun/UV Exposure | Time outdoors, tanning beds, sunburn history |
| Medications & Supplements | Prescription drugs, vitamins, herbal products |
| Questions | Diagnosis, care plan, specialist options |
Doctorโs Questions to Expect
The healthcare provider will want details about your condition. Common questions include:
- When did your symptoms first appear, and how have they changed?
- What makes your skin changes better or worse?
- Have you had lots of sun exposure or used tanning beds? Which areas of your body are most affected?
- Do you have previous skin conditions or a history of skin cancer?
- Have you ever had immune system problems like HIV? What treatments have you tried?
- Are you currently seeing a cancer center or another specialist?
