Toward Better Management of Merkel Cell Carcinoma Using a Consensus Staging System, New Diagnostic Codes and a Recently Discovered VirusHacia un mejor tratamiento del carcinoma de células de merkel utilizando una estadificación de consenso, nuevos códigos diagnósticos y un virus descubierto recientemente

https://doi.org/10.1016/S0001-7310(09)73378-2Get rights and content

Abstract

Merkel cell carcinoma (MCC) is a neuroendocrine skin cancer with a higher propensity for recurrence and metastasis than melanoma or squamous cell carcinoma. Despite aggressive behavior and the tripling of its reported incidence in the past 20 years, there is extensive confusion about how MCC should be managed. Here we address two issues that have impeded optimal MCC management: lack of a consensus staging system and lack of unique diagnostic codes for MCC. Five conflicting systems currently used to stage MCC will be replaced by one system in 2010 that will diminish confusion about prognosis and management among physicians and patients. The diagnostic bundling of MCC with numerous less aggressive skin cancers leads to care refusals by insurance and an inability to track MCC care costs. Worldwide adoption in 2009 of specific diagnostic codes for MCC will also improve understanding and management of this often-lethal skin cancer.

Resumen

El carcinoma de células de Merkel (CCM) es una neoplasia cutánea neuroendocrina con una mayor propensión para desarrollar recurrencias y metástasis que el melanoma o el carcinoma epidermoide. A pesar de su comportamiento agresivo, y el hecho de que su incidencia se haya triplicado en los últimos 20 años, aún existe una gran confusión respecto al tratamiento del CCM. En esta revisión abordaremos dos cuestiones que han dificultado el tratamiento óptimo del CCM: la carencia de un sistema de estadificación consensuado y la falta de códigos diagnósticos exclusivos para el CCM. Los 5 sistemas contradictorios que actualmente se utilizan para estadificar el CCM serán reemplazados solamente por uno en 2010, lo que disminuirá la confusión sobre el pronóstico y el tratamiento entre los médicos y pacientes. La codificación diagnóstica del CCM, junto con numerosas neoplasias cutáneas menos agresivas, ha condicionado la denegación de atención por parte de las compañías aseguradoras y la incapacidad para evaluar los costes de la atención sanitaria por CCM.

La adopción, que se ha efectuado en 2009, de códigos diagnósticos específicos para el CCM también mejorará la comprensión y el tratamiento de esta neoplasia cutánea frecuentemente letal.

References (28)

  • Albores-Saavedra J, Batich K, Chable-Montero F, Sagy N, Schwartz AM, Henson DE. Merkel cell carcinoma demographics,...
  • I. Penn et al.

    Merkel's cell carcinoma in organ recipients: report of 41 cases

    Transplantation

    (1999)
  • H. Feng et al.

    Clonal integration of a polyomavirus in human Merkel cell carcinoma

    Science

    (2008)
  • A. Kassem et al.

    Merkel cell polyomavirus sequences are frequently detected in nonmelanoma skin cancer of immunosuppressed patients

    Int J Cancer

    (2009)
  • Cited by (10)

    • Merkel cell carcinoma from 2008 to 2012: Reaching a new level of understanding

      2013, Cancer Treatment Reviews
      Citation Excerpt :

      The most important feature of this new system is the addition of sub-stages for local and nodal disease, based on the method of nodal examination for local disease and extent of involvement for nodal disease. If only clinical nodal staging was performed, the chance of missing microscopic nodal involvement is approximately 32%.33 Sentinel lymph node biopsy (SLNB) is an important procedure for determining the microscopic involvement of nodes and thus the prognosis.

    • Pathologic nodal evaluation improves prognostic accuracy in Merkel cell carcinoma: Analysis of 5823 cases as the basis of the first consensus staging system

      2010, Journal of the American Academy of Dermatology
      Citation Excerpt :

      Here we present the prognostic analysis used to derive the first unified staging system for MCC. It is anticipated that this staging system, along with the recent introduction of 7 new MCC-specific diagnostic codes (International Classification of Diseases, Ninth Revision, Clinical Modification),21 will aid in standardizing language used to describe MCC and its prognosis among patients, clinicians, and researchers. This staging system is the result of multidisciplinary consensus meetings that analyzed NCDB data from more than 10 times as many patients as any of the prior MCC staging systems.

    • Merkel cell carcinoma

      2010, Annals of Oncology
      Citation Excerpt :

      The presence of micrometastases in the sentinel lymph nodes appears to denote poorer prognosis. When distant metastases are expected the appropriate imaging of the various organs should be performed [29]. Somatostatin receptor scintigraphy does not appear very suited to determining tumor spread.

    • Clinical Recognition, Diagnosis, and Staging of Merkel Cell Carcinoma, and the Role of the Multidisciplinary Management Team

      2010, Current Problems in Cancer
      Citation Excerpt :

      The lack of specific codes also made it far more difficult to track the costs and impact of Merkel cell carcinoma on the health care system as these are the codes used to track billing and insurance fees. The Merkel cell carcinoma Multicenter Interest Group17 realized that this issue was an impediment in management and petitioned the US Centers for Disease Control and Prevention to address this.18 Merkel cell carcinoma was thus assigned 7 new, disease-specific codes (Table 3) that were made active on October 1, 2009.

    • Rapidly growing gastric metastasis of Merkel cell carcinoma, an unusual cause of melena

      2016, Acta Clinica Belgica: International Journal of Clinical and Laboratory Medicine
    View all citing articles on Scopus
    *

    These authors contributed equally

    View full text