Merkel Cell Carcinoma
What is Merkel Cell Carcinoma?
Merkel cell carcinoma is a rare type of skin cancer that usually appears as a flesh-colored or bluish-red nodule, often on your face, head or neck. Merkel cell carcinoma is also called neuroendocrine carcinoma of the skin.
Merkel cell carcinoma most often develops in older people. Long-term sun exposure or a weak immune system may increase your risk of developing Merkel cell carcinoma.
Merkel cell carcinoma tends to grow fast and to spread quickly to other parts of your body. Treatment options for Merkel cell carcinoma often depend on whether the cancer has spread beyond the skin.
About Iranian Surgery
Iranian surgery is an online medical tourism platform where you can find the best surgeons to treat your skin cancer in Iran. The price of Merkel Cell Carcinoma Treatment in Iran can vary according to each individual’s case and will be determined by the type of treatment you have and an in-person assessment with the doctor.
For more information about the cost of Merkel Cell Carcinoma Treatment in Iran and to schedule an appointment in advance, you can contact Iranian Surgery consultants via WhatsApp number 0098 901 929 0946.
Before Merkel Cell Carcinoma Treatment
Symptoms
The first sign of Merkel cell carcinoma is usually a fast-growing, painless nodule (tumor) on your skin. The nodule may be skin-colored or may appear in shades of red, blue or purple. Most Merkel cell carcinomas appear on the face, head or neck, but they can develop anywhere on your body, even on areas not exposed to sunlight.
When to see a doctor
If you notice a mole, freckle or bump that is changing in size, shape or color, growing rapidly, or bleeding easily after minor trauma, such as washing your skin or shaving, make an appointment with your doctor.
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Causes
It's not clear what causes Merkel cell carcinoma. Merkel cell carcinoma begins in the Merkel cells. Merkel cells are found at the base of the outermost layer of your skin (epidermis). Merkel cells are connected to the nerve endings in the skin that are responsible for the sense of touch.
Researchers recently discovered that a common virus plays a role in causing most cases of Merkel cell carcinoma. The virus (Merkel cell polyomavirus) lives on the skin and doesn't cause any signs or symptoms. Just how this virus causes Merkel cell carcinoma has yet to be determined. Given that the virus is very common and Merkel cell carcinoma is very rare, it's likely that other risk factors play a role in the development of this cancer.
Risk factors
Factors that may increase your risk of Merkel cell carcinoma include:
. Excessive exposure to natural or artificial sunlight. Being exposed to ultraviolet light, such as the light that comes from the sun or from tanning beds, increases your risk of Merkel cell carcinoma. The majority of Merkel cell carcinomas appear on skin surfaces frequently exposed to sun.
. A weakened immune system. People with weakened immune systems — including those with HIV infection, those taking drugs that suppress the immune response or those with chronic leukemias — are more likely to develop Merkel cell carcinoma.
. History of other skin cancers. Merkel cell carcinoma is associated with the development of other skin cancers, such as basal cell or squamous cell carcinoma.
. Older age. Your risk of Merkel cell carcinoma increases as you age. This cancer is most common in people older than age 50, though it can occur at any age.
. Light skin color. Merkel cell carcinoma usually arises in people who have light-colored skin. Whites are much more likely to be affected by this skin cancer than are blacks.
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Complications
Cancer that spreads to other parts of the body
Even with treatment, Merkel cell carcinoma commonly spreads (metastasizes) beyond the skin. Merkel cell carcinoma tends to travel first to nearby lymph nodes. Later it may spread to your brain, bones, liver or lungs, where it can interfere with the functioning of these organs. Cancer that has metastasized is more difficult to treat and can be fatal.
Prevention
While exposure to sunlight isn't proved to cause Merkel cell carcinoma, it is considered a risk factor for this cancer. Reducing your sun exposure may reduce your risk of skin cancer. Try to:
. Avoid the sun during peak hours. Avoid sun exposure as much as possible during the strongest sunlight hours of the day — typically from 10 a.m. to 4 p.m. Move your outdoor activities to a time earlier in the morning or later in the day.
. Shield your skin and eyes. Wear a wide-brimmed hat, tightly woven clothing and sunglasses with ultraviolet (UV) light protection.
. Apply sunscreen liberally and often. Use a broad-spectrum sunscreen with an SPF of at least 30, even on cloudy days. Apply sunscreen generously, and reapply every two hours — or more often if you're swimming or perspiring.
. Watch for changes. If you notice a mole, freckle or bump that's changing in size, shape or color, talk to your doctor. Most skin nodules never become cancer, but catching cancer in its early stages increases the chances that treatment will be successful.
Diagnosis
Tests and procedures used to diagnose Merkel cell carcinoma include:
. Physical exam. Your doctor will examine your skin for unusual moles, freckles, pigmented spots and other growths.
. Removing a sample of suspicious skin. During a procedure called a skin biopsy, your doctor removes the tumor or a sample of the tumor from your skin. The sample is analyzed in a laboratory to look for signs of cancer.
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Determining the extent
Your doctor may use the following tests to help determine whether the cancer has spread beyond your skin:
. Sentinel node biopsy. A sentinel node biopsy is a procedure to determine whether cancer has spread to your lymph nodes. This procedure involves injecting a dye near the cancer. The dye then flows through the lymphatic system to your lymph nodes.
The first lymph nodes that receive the dye are called the sentinel nodes. Your doctor removes these lymph nodes and looks for cancerous cells under a microscope.
. Imaging tests. Your doctor may recommend a chest X-ray and a CT scan of your chest and abdomen to help determine whether the cancer has spread to other organs.
Your doctor may also consider other imaging tests such as a positron emission tomography (PET) scan or an octreotide scan — a test that uses an injection of a radioactive tracer to check for the spread of cancer cells.
During Merkel Cell Carcinoma Treatment
Stages of Merkel cell carcinoma
After receiving a cancer diagnosis, your doctor will run tests to find out if the cancer has spread to other parts of your body. This is referred to as staging. Staging is important for determining what types of treatment are needed.
In general, a higher number stage means the further a cancer has spread. There are five main stages in MCC (stages 0 to 4):
. Stage 0: the cancer is only in the epidermis and hasn’t spread to the lymph nodes
. Stage 1: the cancer is less than 2 centimeters (cm) across and hasn’t grown into the lymph nodes.
. Stage 2: the cancer is more than 2 cm across and hasn’t spread to the lymph nodes
. Stage 3: the cancer has grown into lymph nodes as well as nearby tissues
. Stage 4: the cancer has spread to nearby tissues, the lymph nodes, and distant sites, such as the lungs, bones, or brain.
Treatment
Treatments for Merkel cell carcinoma can include:
. Surgery. During surgery, your doctor removes the tumor along with a border of normal skin surrounding the tumor. If there's evidence that the cancer has spread to lymph nodes in the area of the skin tumor, those lymph nodes are removed (lymph node dissection).
The surgeon most often uses a scalpel to cut away the cancer. In some cases, your doctor may use a procedure called Mohs surgery.
During Mohs surgery, thin layers of tissue are methodically removed and analyzed under a microscope to see whether they contain cancer cells. If cancer is found, the surgical process is repeated until cancer cells are no longer visible in the tissue. This type of surgery takes out less normal tissue — thereby reducing scarring — but ensures a tumor-free border of skin.
. Radiation therapy. Radiation therapy involves directing high-energy beams, such as X-rays and protons, at cancer cells. During radiation treatment, you're positioned on a table and a large machine moves around you, directing the beams to precise points on your body.
Radiation therapy is sometimes used after surgery to destroy any cancer cells that remain after the tumor is removed.
Radiation may also be used as the sole treatment in people who choose not to undergo surgery. Radiation can also be used to treat areas where the cancer has spread.
. Immunotherapy. In immunotherapy, drugs are used to help your immune system fight cancer. Most often, immunotherapy is used to treat Merkel cell carcinoma that has spread to other areas of your body.
. Chemotherapy. Chemotherapy uses drugs to kill the cancer cells. Chemotherapy drugs can be administered through a vein in your arm or taken as a pill or both.
Chemotherapy is not used often, but your doctor may recommend it if your Merkel cell carcinoma has spread to your lymph nodes or other organs in your body, or if it has returned despite treatment.
After Merkel Cell Carcinoma Treatment
What is the outlook for Merkel cell carcinoma?
Merkel call carcinoma is uncommon, so it’s difficult to estimate an accurate survival rate. The survival rate tells you what percentage of people with the same type and stage of cancer are still alive after a defined period of time after diagnosis.
According to the American Cancer Society, the overall five-year survival rate for MCC is about 60 percent. This means that about 60 percent of people diagnosed with MCC will still be alive after five years.
Your outlook depends on how early the cancer is diagnosed. The following five-year relative survival rates are based on stages 1 through 4 of diagnosis:
. Stage 1A: 80 percent
. Stage 1B: 60 percent
. Stage 2A: 60 percent
. Stage 2B: 50 percent
. Stage 3A: 45 percent
. Stage 3B: 25 percent
. Stage 4: 20 percent
People with weakened immune systems or who are very old tend to have a worse outlook.