Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2012, 156(3):213-217 | DOI: 10.5507/bp.2012.033

Merkel cell carcinoma. A review

Richard Pinka, Jiri Ehrmannb, Martin Molitorc, Peter Tvrdya, Petr Michla, Jindrich Pazderaa, Jan Hanuliaka
a Department of Oral and Maxillofacial Surgery, University Hospital Olomouc, Czech Republic
b Department of Pathology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc
c Department of Plastic and Aesthetic Surgery, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc

Background: Merkel cell carcinoma (MCC) is a rare potentially fatal skin tumour affecting older mainly white people and younger immunosuppressed individuals. While uncommon, the incidence is increasing relative to melanoma and with twice the lethality. The benign appearance of the tumour usually on exposed skin parts, contrasting with its extensive microscopic invasion, can delay timely diagnosis. Recurrent MCC is currently attributed to the recently discovered Merkel cell polyomavirus This brief review of MCC covers the history, epidemiology,etiology,clinical and histological features, treatment and prognosis.

Methods: Literature search using PubMed and search words Merkel cell carcinoma (MCC), etiology, treatment for the years 1972 to 2010.

Results and conclusion: Merkel cell carcinoma is a rare malignancy with uncertain prognosis. Due to the uncommon occurrence and dearth of randomized studies, there is no agreement on optimal treatment. The tumor has only recently been included in the international classification of tumors (NCCN). The treatment approaches found to be best are radical surgery of primary tumor, drainage of lymph node extension and possibly adjuvant loco-regional radiotherapy. The basis of successful treatment however, remains prevention regular dermatological examination in immunosuppressed patients and early initiation of combination therapy, based on radical surgery supplemented by radiotherapy and palliative chemotherapy in the last resort.

Keywords: merkel cell carcinoma (MCC), etiology, treatment

Received: November 1, 2011; Accepted: February 28, 2012; Prepublished online: June 1, 2012; Published: September 1, 2012  Show citation

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Pink, R., Ehrmann, J., Molitor, M., Tvrdy, P., Michl, P., Pazdera, J., & Hanuliak, J. (2012). Merkel cell carcinoma. A review. Biomedical papers156(3), 213-217. doi: 10.5507/bp.2012.033
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References

  1. Toker C. Trabecular carcinoma of the skin. Archives for dermatological research 1972;105:107-10. Go to original source... Go to PubMed...
  2. Van Keymeulen A, Mascre G, Youseff KK. Epidermal progenitors give rise to Merkel cells during embryonic development and adult homeostasis. Journal of cell biology 2009;187(1):91-100. Go to original source... Go to PubMed...
  3. Mottl H, Abrahamova J. Nador z Merkelovych bunek u dvoulete divky-kazuistika. Klinicka onkologie 1990;3(1):19-21.
  4. Schmid C, Beham A, Feichtinger J. Recurrent and subsequently metastasizing Merkel cell carcinoma in a 7- year-old girl. Histopathology 1992;20(5):437-9. Go to original source... Go to PubMed...
  5. Hodgson NC. Merkel cell carcinoma: changing incidence trends. Journal of surgical oncology 2005;89(1):1-4. Go to original source... Go to PubMed...
  6. Brenner B, Sulkes A, Rakowsky E. Second neoplasmas in patients with Merkel cell carcinoma. Cancer 2001;91:1358-62. Go to original source... Go to PubMed...
  7. Buel JF, Gross TG, Woodle ES. Malignancy after transplantation. Transplantation 2005;15:254-8. Go to original source... Go to PubMed...
  8. Feng H, Shuda M, Chang Y. Clonal integration of polyomavirus in human Merkel cell carcinoma. Science 2008;319(5866):1096-100. Go to original source... Go to PubMed...
  9. Pages F, Berger A, Camus M. Effector memory T cells, early metastasis and survival in colorectal cancer. New England journal of medicine 2005;353:2654-6. Go to original source... Go to PubMed...
  10. Dantal J, Huormant M, Cantarovich D. Effect of long-term immunosuppression in kidney-graft recipients on cancer incidence: randomised comparison of two cyklosporin regiments. Lancet 1998;351:623-8. Go to original source... Go to PubMed...
  11. Goepfer H, Remmier D, Silva E, Wheller B. Merkel cell carcinoma (endocrine carcinama of the skin) of the head and neck. Archives of otolaryngology 1984;110:707-12. Go to original source... Go to PubMed...
  12. Medina-Franco H, Urist MM, Fiveash J. Multimodality treatement of Merkal cell carcinoma: case series and literature review of 1024 cases. Annals of surgical oncology 2001;8:204-8. Go to original source... Go to PubMed...
  13. Helmbold P, Schoter S, Holzhausen HJ, et al. Merkel cell carcinoma: a diagnostic and therapeutic challenge. Chirurgia 2001;72:396-401. Go to original source...
  14. Tai PT, Yu E, Tonita J, et al. Merkel cell carcinoma of the skin. Journal of Cutaneus Pathology 2000;4(4):186-96. Go to original source... Go to PubMed...
  15. Vantuchova Y. Karcinom z Merkelovych bunek. Dermatologie pro praxi 2008;2(1):23-5.
  16. Johansson L, Tennvall J, Akerman M. Immunohistochemical examination of 25 cases of Mekel cell carcinoma: comparison with small cell carcinoma of the lung and oesophagus, and a review of the literature. APMIS 1990;98:741-52. Go to original source... Go to PubMed...
  17. Schmidt U, Muller U, Metz KA, Leder LD. Cytokeratin and neurofilament protein staining in Merkel cell carcinoma of the small cell type and small cell carcinoma of the lung. Americal Journal of dermatopathology 1998;20:346-51. Go to original source... Go to PubMed...
  18. Miettinen M. Keratin 20: immunohistochemical marker for gastrointestinal, urothelial and Merkel cell carcinimas. Modern Pathology 1995;8:384-88.
  19. Scott MP, Helm KF. Cytokeratin 20: a marker for diagnostic Merkel cell carcinoma. Americal Journal of Dermatopathology 1999;21:16-20. Go to original source... Go to PubMed...
  20. Lazzaro D, Price M, de Felice M, Di Lauro R. The transcription factor TTF-I is expressed at the onset of thyroid and lung morphogenesis and in restricted regions of the foetal brain. Development 1991;113:1093-104. Go to original source... Go to PubMed...
  21. Byrd-Gloster AL, Khoor A, Glass LF, Messina JL, Whitsett JA, Livigston SK, Cagle PT. Differential expression of thyroid factor TTF-I in small lung carcinoma and Merkel cell tumor. Human Pathology 2000;31:58-62. Go to original source... Go to PubMed...
  22. Metz KA, Jacob M, Schmidt U, Steuhl KP, Leder LD. Merkel cell carcinoma of the eyelid: histological and immunohistochemical features with special respect to differential diagnosis. Graefes Archive for Clinical and Experimental Ophthalmology 1998;236:561-66. Go to original source... Go to PubMed...
  23. Leong AS, Phillips GE, Pieterse AS, Milios J. Criteria for the diagnosis of primary endocrine carcinoma of the skin (Merkel cell carcinoma). A histological, immunohistochemical and ultrastructural study of 13 cases. Pathology 1986;18:393-99. Go to original source... Go to PubMed...
  24. Kurokawa M, Nabeshima K, Akiyama Y, Maeda S, Nishida T, Nakayama F, Amano M, Ogata K, Setoyama M. CD56: a useful marker for diagnosing Merkel cell carcinoma. Journal of Dermatological Science 2003;31:219-24. Go to original source... Go to PubMed...
  25. Gallego R, Garcia-Caballero T, Fraga M, Beiras A, Forteza J. Neural cell adhesion molecule immunoreactivity in Merkel cells and Merkel cell tumours. Virchows Archiv 1995;426:317-21. Go to original source... Go to PubMed...
  26. Koljonen V, Haglund C, Tukiainen E, Bohling T. Neuroendocrine differentiation in primary Merkel cell carcinoma--possible prognostic significance. Anticancer Research 2005;25:853-8. Go to PubMed...
  27. Liu Y, Sturgis CD, Grzybicki DM, Jasnosz KM, Olson PR, Tong M, Dabbs DD, Raab SS, Silverman JF. Microtubule-associated protein-2: a new sensitive and specific marker for pulmonary carcinoid tumor and small cell carcinoma. Modern Pathology 2001;14:880-5. Go to original source... Go to PubMed...
  28. Liu Y, Saad RS, Shen SS, Silverman JF. Diagnostic Value of Microtubule-Associated Protein-2 (MAP-2) for Neuroendocrine. Neoplasms advances in anatomic pathology 2003;10:101-6. Go to original source... Go to PubMed...
  29. Liu Y, Mangini J, Saad R, Silverman AR, Abell E, Tung MY, Graner SR, Silverman JF. Diagnostic value of microtubule-associated protein-2 in Merkel cell carcinoma. Applied immunohistochemistry molecular morphology 2003;11:326-9. Go to original source... Go to PubMed...
  30. Tarkkanen M, Knuutila S. The diagnostic use of cytogenetic and molecular genetic techniques in the assessment of small round cell tumours. Current Diagnostic Pathology 2002;8:338-48. Go to original source...
  31. Pisick E, Skarin AT, Salgia R. Recent advances in the molecular biology, diagnosis and novel therapies for various small blue cell tumors. Anticancer Research 2003;23:3379-96. Go to PubMed...
  32. Shaw JH, Rumball WB. Merkel cell tumour: clinical behavior and treatment. British journal of Sumery 1991;78(2):138-42. Go to original source... Go to PubMed...
  33. Leonard JH, Ramsay JR, Kearsley JH, Birrell GW. Radiation sensitivity of Merkel cell carcinoma cell lines. International Journal of Radiation Oncology 1995;32:1401-7. Go to original source...
  34. Herbst A, Haynes HA, Nghiem P. The standard of care for Merkel cell carcinoma should include adjuvant radiation and lymph node surgery. Journal of the American academy of dermatology 2002;46:640-2. Go to original source... Go to PubMed...
  35. Tai PT, Yu E, Winquist E, Hammond A, Stitt L, Tonita J, Gilchrist J.. Chemotherapy in neuroendrine/Merkel cell carcinoma of the skin: case series and review of 204 cases. Journal of clinical onco­logy 2000;18(12):2493-9. Go to original source... Go to PubMed...
  36. Maubec E, Duvillard P, Velasco V, Crickx B, Avril MF. Immunohistochemical analysis of EGFR and HER-2 in patiens with metastasis squamous cell carcinoma of the skin. Anticancer Research 2005;25(2B):1205-10. Go to PubMed...
  37. Krasagakis K, Kruger-Krasagagis S, Tzanakakis GN, Darivianaki K, Stathopoulos EN, Tosca AD. Interferon-alfa inhibits prolifaration and induces apoptosis of Merkel cell carcinoma in vitro. Cancer Investigation 2008;26(6):562-8. Go to original source... Go to PubMed...
  38. Eng TY, Boersma MG, Fuller CD, Cavanaugh SX, Valenzuela F, Herman TS. Treatment of Merkel Cell carcinoma. American Journal of Clinical Oncology 2004; 27(5):510-5. Go to original source... Go to PubMed...
  39. Sadahira Y, Nakamoto S, Mori M, Hsueh CL, Awai M. Merkel cell tumor coexpressing cytokeratin and neurofilament proteins. Acta pathologicy japn 1987;37:331-7. Go to original source...
  40. Vaigot P, Pisani A, Darmon YM, Ortonne JP. The majority of epidermal Merkel cells are non-proliferative: a quantitative immunofluorescence analysis. Acta dermatologica venerologica 1987;67:517-20.
  41. Swick BL, Ravdel L, Fitzpatrick JE, Robinson WA. Platelet-derived growth factor receptor alpha mutational status and immunohistochemical expression in Merkel cell carcinoma: implications for treatment with imatinib mesylate. Journal of Cutaneous Pathology. 2008;35(2):197-202. Go to original source... Go to PubMed...
  42. Brunner M, Thurnher D, Pammer J, Geleff S, Heiduschka G, Reinisch CM, Petzelbauer P, Erovic BM. Expression of VEGF-A/C, VEGF-R2, PDGF-alpha/beta, c-kit, EGFR, HER-2/Neu, Mcl-1 and Bmi-1 in Merkel cell carcinoma. Modern Pathology 2008;21(7):876-84. Go to original source... Go to PubMed...
  43. Horn HF, Vousden KH. Coping with stress: multiple ways to activate p53. Oncogene 2007;26(9):1306-16. Go to original source... Go to PubMed...
  44. Popp S, Waltering S, Herbst C, Moll I, Boukamp P. UV- B-type mutations and chromosomal imbalances indicate common pathways for the development of Merkel and skinsquamous cell carcinomas. International Journal of Cancer 2002;99(3):352-60. Go to original source... Go to PubMed...
  45. Van Gele M, Kaghad M, Leonard JH, Van Roy N, Naeyaert JM, Geerts ML, Van Belle S, Cocquyt V, Bridge J, Sciot R, De Wolf-Peeters C, De Paepe A, Caput D, Speleman F. Mutation analysis of P73 and TP53 in Merkel cell carcinoma. British Journal of Cancer 2000;82(4),823-6. Go to original source... Go to PubMed...
  46. Asioli S, Righi A, Volante M, Eusebi V, Bussolati G. p63 expression as a new prognostic marker in Merkel cell carcinoma. Cancer 2007;110(3):640-7. Go to original source... Go to PubMed...
  47. Cottel WI, Bailin PL, Albom MJ, Bernstein G, Braun M, Hanke CW, Sutnick TB, Swanson NA. Essentials of Mohs micrographic surgery. Journal of dermatologic surgery and oncology. 1988;14:11-13. Go to original source... Go to PubMed...
  48. Brissett AE, Olsen KD, Kasperbauer JL, Lewis JE, Goellner JR, Spotts BE, Weaver AL, Strome SE. Merkel cell carcinoma of the head and neck: a retrospective case series. Head Neck 2002;24:982-8. doi: 10.1002/hed.10153. Go to original source... Go to PubMed...
  49. Connelly TJ, Cribier B, Brown TJ, Yanguas I. Complete spontaneous regression of Merkel cell carcinoma: a review of the 10 reported cases. Dermatologic Surgery 2000;26:853-6. Go to original source... Go to PubMed...
  50. Mori Y, Hashimoto K, Tanaka K, Cui CY, Mehregan DR, Stiff MA. A study of apoptosis in Merkel cell carcinoma: an immunohistochemical, ultrastructural, DNA ladder, and TUNEL labeling study American Journal of dermathopatology 2001;23:16-23. Go to original source... Go to PubMed...
  51. Inoue T, Yoneda K, Manabe M, Demitsu T. Spontaneous regression of merkel cell carcinoma: a comparative study of TUNEL index and tumor-infiltrating lymphocytes between spontaneous regression and non-regression group. Journal of Dermatological Science 2000;24:203-11. Go to original source... Go to PubMed...