Materiały źródłowe

• #1 Merkel Cell Carcinoma: Symptoms, Causes, Stages & Treatment

  https://my.clevelandclinic.org/health/diseases/17971-merkel-cell-carcinoma

  Merkel cell carcinoma is a rare but aggressive type of skin cancer that can be life-threatening. […] Healthcare providers surgically remove the tumor, but the cancer often comes back. […] The number of people receiving a Merkel cell carcinoma diagnosis is steadily increasing. This increase may be due to improved diagnostic tests. […] A dermatologist diagnoses and treats skin diseases like Merkel cell carcinoma. […] Your healthcare provider will perform a full-body skin exam. They may feel for swollen lymph nodes, which can indicate infection or potential cancer spread. You’ll receive a skin biopsy of the tumor to check for cancer cells. […] Healthcare providers use cancer staging to determine the extent of cancer spread. Staging happens soon after diagnosis. The higher the stage number, the more severe the cancer spread.

• #2 Merkel Cell Carcinoma

  https://www.skincancer.org/skin-cancer-information/merkel-cell-carcinoma/

  Merkel cell carcinoma (MCC) is a rare, aggressive form of skin cancer with a high risk for returning (recurring) and spreading (metastasizing), often within two to three years after initial diagnosis. […] Approximately 3,000 new cases of Merkel cell skin cancer are diagnosed annually in the U.S. About 40 percent of cases recur. […] Fortunately, options for managing recurrent disease have increased markedly with the introduction of immunotherapy treatments. […] While MCC is about three to five times more likely to be deadly than melanoma, with early detection, MCC can be treated successfully. If you think you might have MCC, see your doctor. Treatment becomes increasingly difficult once the disease has spread, but new options are now available. Thanks to advances in the field of immunotherapy, MCC survival rates are improving.

• #3 Merkel cell carcinoma – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/merkel-cell-carcinoma/diagnosis-treatment/drc-20351036

  Merkel cell carcinoma diagnosis often starts with an exam. A healthcare professional may look at your skin and remove a sample of cells for testing. This skin cancer may be hard to diagnose because it may look like other skin growths. […] A biopsy is a procedure to remove a sample of tissue for testing in a lab. For Merkel cell carcinoma, a healthcare professional may use a tool to cut away some of the concerning skin. Other ways to do a skin biopsy involve using a shaving tool or a circular cutting tool to get some of the skin. The sample is tested in a lab to see if it is cancer. […] Your healthcare professional may use other tests to find out whether the cancer has spread beyond your skin. These other tests may include: […] A sentinel node biopsy is a procedure to see whether cancer has spread to the lymph nodes. This procedure involves putting a dye into the skin near the cancer. The dye then flows through the lymphatic system to the lymph nodes. […] Imaging tests used to look for signs that the cancer has spread include a chest X-ray, a CT scan of the chest and belly, and a positron emission tomography scan, also called a PET scan. […] For Merkel cell carcinoma, questions might include: What tests do I need?

• #4 Merkel Cell Carcinoma: Symptoms, Causes, Stages & Treatment

  https://my.clevelandclinic.org/health/diseases/17971-merkel-cell-carcinoma

  Merkel cell carcinoma is a rare but aggressive type of skin cancer that can be life-threatening. […] Healthcare providers surgically remove the tumor, but the cancer often comes back. […] The number of people receiving a Merkel cell carcinoma diagnosis is steadily increasing. This increase may be due to improved diagnostic tests. […] A dermatologist diagnoses and treats skin diseases like Merkel cell carcinoma. […] Your healthcare provider will perform a full-body skin exam. They may feel for swollen lymph nodes, which can indicate infection or potential cancer spread. You’ll receive a skin biopsy of the tumor to check for cancer cells. […] Healthcare providers use cancer staging to determine the extent of cancer spread. Staging happens soon after diagnosis. The higher the stage number, the more severe the cancer spread.

• #5 Skin cancer types: Merkel cell carcinoma diagnosis & treatment

  https://www.aad.org/public/diseases/skin-cancer/types/common/merkel-cell/treatment

  Merkel cell carcinoma (MCC) is a rare cancer that requires specialized knowledge and equipment to find it. For this reason, the American Academy of Dermatology (AAD) recommends that you ask whether your doctor: […] Has experience diagnosing MCC […] Will work with a dermatopathologist to diagnose you. […] When a doctor who has expertise in diagnosing MCC suspects that you may have this rare skin cancer, the diagnosis involves these steps: […] Your doctor looks at your skin and feels the lymph nodes closest to the growth that could be MCC. Its important to feel the lymph nodes because MCC is an aggressive cancer that can spread quickly. […] If the tumor looks like it could be MCC, your doctor will remove all (or part of it) so that the tumor can be examined under a high-powered microscope. Special techniques are required to find MCC, so the doctor who will look at it under a microscope should be an experienced dermatopathologist.

• #6 Merkel Cell Carcinoma—Update on Diagnosis, Management and Future Perspectives

  https://www.mdpi.com/2072-6694/15/1/103

  Merkel cell carcinoma (MCC) is a rare, aggressive, neuroendocrine malignancy of the skin, first described by Toker in 1972. MCC usually presents as a firm, painless, nodular, or plaque-like, flesh-colored to red-violet lesion, with a high affinity for the head and neck or upper extremities. Its most important features are represented by the acronym AEIOU: Asymptomatic/lack of tenderness, Expanding rapidly, Immune deficiency, age Older than 50 years, and UV exposure. A biopsy of a suspicious lesion is required for the diagnosis of MCC, followed by an immunopanel analysis. Diagnosis using light microscopy alone can lead to a wrong diagnosis in 60% of primary tumors and 40% of LN examinations. Immunohistochemical staining is required to exclude possible mimickers, such as small-cell lung carcinoma metastasis, lymphoma, and small-cell melanoma. Tumor cells in MCC typically express markers of neuroendocrine and epithelial differentiation, such as neuron-specific enolase (NSE), CD56, chromogranin A, synaptophysin, and low molecular weight cytokeratins (CK8, CK18, CK19, CK20), CAM 5.2, and AE1/AE3. CK20 is a diagnostic marker with high sensitivity and specificity. CK20 is positive in 80% of biopsies with characteristic membranous, punctate, and/or ‘paranuclear dot-like patterns. Expression of CK20 with the concomitant absence of TTF-1 expression is diagnostic for MCC in 90% of cases. After the diagnosis is confirmed by biopsy, a total body examination including LN evaluation for clinically detectable metastasis must be performed. The National Comprehensive Cancer Network (NCCN) guidelines recommend a systematic baseline cross-sectional imaging at diagnosis. The preferred imaging modalities are ultrasound of the locoregional LN, whole-body positron emission tomography (PET)-computed tomography (CT), or thoracic, abdomen, and pelvis CT with contrast. Occult LN metastasis can be detected in 20–40% of MCC patients, at the time of diagnosis and independently of the primary tumor size. Thus, LN status should be determined systematically at diagnosis as it is an important staging tool and an independent prognostic factor for overall survival (OS). If LN metastasis is clinically detected, imaging studies and subsequent exploratory lymphadenectomy should be performed. All other cases should undergo a sentinel lymph node biopsy (SLNB). Ideally, SLNB should be performed alongside primary tumor-wide local excision (WLE) or precede it to avoid WLE-related lymphatic drainage modifications.

• #7 Merkel Cell Carcinoma (MCC) > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/merkel-cell-carcinoma-mcc

  How is Merkel cell carcinoma diagnosed? When doctors suspect Merkel cell carcinoma, they will examine the area, obtain a health history from the patient, and perform a biopsy to diagnose the condition. […] To diagnose Merkel cell carcinoma, the doctor will closely examine any lesions and bumps on the skin, checking for features that may indicate Merkel cell carcinoma. The features correspond to the acronym AEIOU: […] Doctors typically suspect Merkel cell carcinoma in people with three or more of these features. In these cases, doctors will biopsy the site to check for the presence of Merkel cell carcinoma cells. A blood test may also be used to check for the presence of Merkel cell polyomavirus antibodies or for circulating tumor DNA in order to assist with surveillance and management of Merkel cell carcinoma.

• #8 Merkel cell carcinoma

  https://dermnetnz.org/topics/merkel-cell-carcinoma

  Merkel cell carcinoma should be considered in any tumour with „AEIOU” clinical features, which are present in about 90% of patients with the disease. […] The main test is a biopsy of the tumour. This shows characteristic Merkel cell carcinoma pathology. Immunohistochemistry can be helpful as cytokeratin-20 (CK20) is positive in up to 95% of tumours and thyroid transcription factor (TTF1) is usually negative. […] A general examination, including evaluation of local lymph nodes, and staging investigations may be arranged to determine whether the tumour has spread to other sites. […] Staging investigations may include: Sentinel node biopsy, Lymph node ultrasound scan, Imaging using X-rays, computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) scans. […] A specific Merkel cell carcinoma staging system is published by the American Joint Committee on Cancer.

• #9 Tests for Merkel Cell Carcinoma | American Cancer Society

  https://www.cancer.org/cancer/types/merkel-cell-skin-cancer/detection-diagnosis-staging/how-diagnosed.html

  Most skin cancers, including Merkel cell carcinoma (MCC), are brought to a doctors attention because a person has noticed a change in an area of skin. […] If Merkel cell carcinoma is diagnosed, you will probably need other tests as well to learn more about it, including if it has spread. […] If the doctor thinks that a suspicious area might be Merkel cell cancer or another type of skin cancer, the area (or part of it) will be removed. This is called a skin biopsy. […] Merkel cell cancer often spreads to nearby lymph nodes, so its very important to find out if the lymph nodes contain cancer cells. […] A sentinel lymph node biopsy is a surgical procedure that is used to find the lymph nodes that are likely to be the first place Merkel cell cancer would spread to. […] If a lymph node near a Merkel cell cancer tumor is abnormally large, the doctor can use a needle biopsy to find out if the cancer has spread to that node.

• #10 Skin cancer types: Merkel cell carcinoma diagnosis & treatment

  https://www.aad.org/public/diseases/skin-cancer/types/common/merkel-cell/treatment

  Merkel cell carcinoma (MCC) is a rare cancer that requires specialized knowledge and equipment to find it. For this reason, the American Academy of Dermatology (AAD) recommends that you ask whether your doctor: […] Has experience diagnosing MCC […] Will work with a dermatopathologist to diagnose you. […] When a doctor who has expertise in diagnosing MCC suspects that you may have this rare skin cancer, the diagnosis involves these steps: […] Your doctor looks at your skin and feels the lymph nodes closest to the growth that could be MCC. Its important to feel the lymph nodes because MCC is an aggressive cancer that can spread quickly. […] If the tumor looks like it could be MCC, your doctor will remove all (or part of it) so that the tumor can be examined under a high-powered microscope. Special techniques are required to find MCC, so the doctor who will look at it under a microscope should be an experienced dermatopathologist.

• #11 Merkel cell carcinoma – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/merkel-cell-carcinoma/diagnosis-treatment/drc-20351036

  Merkel cell carcinoma diagnosis often starts with an exam. A healthcare professional may look at your skin and remove a sample of cells for testing. This skin cancer may be hard to diagnose because it may look like other skin growths. […] A biopsy is a procedure to remove a sample of tissue for testing in a lab. For Merkel cell carcinoma, a healthcare professional may use a tool to cut away some of the concerning skin. Other ways to do a skin biopsy involve using a shaving tool or a circular cutting tool to get some of the skin. The sample is tested in a lab to see if it is cancer. […] Your healthcare professional may use other tests to find out whether the cancer has spread beyond your skin. These other tests may include: […] A sentinel node biopsy is a procedure to see whether cancer has spread to the lymph nodes. This procedure involves putting a dye into the skin near the cancer. The dye then flows through the lymphatic system to the lymph nodes. […] Imaging tests used to look for signs that the cancer has spread include a chest X-ray, a CT scan of the chest and belly, and a positron emission tomography scan, also called a PET scan. […] For Merkel cell carcinoma, questions might include: What tests do I need?

• #12 Get Merkel Cell Carcinoma Treatment | Cleveland Clinic

  https://my.clevelandclinic.org/services/merkel-cell-carcinoma-treatment

  Diagnosing Merkel Cell Carcinoma at Cleveland Clinic […] Everyone has Merkel cells in their outer layer of skin (epidermis). Exposure to ultraviolet (UV) light from the sun or a tanning bed, or having other risk factors like fair skin or a weakened immune system, can make these cells grow uncontrollably. When they do, they can form cancerous growths that can quickly spread (metastasize). […] Because Merkel cell carcinoma is rare and resembles other skin conditions, diagnosing it can be tough. Its often first mistaken for benign (noncancerous) tumors, cysts or infected hair follicles. By the time its correctly identified, it may have already reached your lymph nodes. […] Accurate and early diagnosis requires the right tests and skilled healthcare providers with experience treating this skin cancer. Cleveland Clinics skin cancer specialists can get you the care you need.

• #13 Merkel Cell Carcinoma Warning Signs and Images

  https://www.skincancer.org/skin-cancer-information/merkel-cell-carcinoma/mcc-warning-signs/

  Merkel cell carcinoma (MCC) is rare and dangerous but treatable, especially when found at an early stage. Be watchful for any new or changing lesions on your skin and look out for these warning signs. […] Diagnosis and management of Merkel cell carcinoma presents distinct challenges, including: Misdiagnosis: 56 percent of MCCs are believed to be benign when initially examined by physicians, who may mistake the tumors for cysts or infected hair follicles. […] Since MCC is a rare and aggressive cancer, delayed detection, diagnosis and treatment are especially concerning, because as the disease progresses, treatment becomes more difficult and the risk of recurrence increases.

• #14 Skin Cancer – Merkel Cell Carcinoma Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/870538-workup

  Diagnosing Merkel cell carcinoma (MCC) is difficult and requires a high degree of suspicion. […] Light microscopy reveals round-to-polygonal neoplastic cells that are compactly arranged. […] Immunohistochemistry is often used to confirm Merkel cell carcinoma (MCC). […] The absence of certain markers also helps in the diagnosis of Merkel cell carcinoma (MCC) by ruling out other tumors.

• #15 Diagnosis and treatment of Merkel cell carcinoma: European consensus-based interdisciplinary guideline – Update 2022 – PubMed

  https://pubmed.ncbi.nlm.nih.gov/35732101/

  Merkel cell carcinoma (MCC) is a rare skin cancer, accounting for less than 1% of all cutaneous malignancies. […] Histopathology (small-cell neuroendocrine appearance) and immunohistochemistry (CK20 positivity and TTF-1 negativity) confirm the diagnosis. […] The current staging systems are the American Joint Committee on Cancer/Union for international Cancer control 8th edition. Baseline whole body imaging is encouraged to rule out regional and distant metastasis. […] Sentinel lymph node biopsy is recommended in all patients with MCC without clinically detectable lymph nodes or distant metastasis. […] Adjuvant RT alone, eventually combined with complete lymph nodes dissection is proposed in case of micrometastatic nodal involvement. […] In case of macroscopic nodal involvement, the standard of care is complete lymph nodes dissection potentially followed by post-operative RT. […] Immunotherapy with anti-PD-(L)1 antibodies should be offered as first-line systemic treatment in advanced MCC.

• #16 Merkel Cell Carcinoma—Update on Diagnosis, Management and Future Perspectives

  https://www.mdpi.com/2072-6694/15/1/103

  Merkel cell carcinoma (MCC) is a rare, aggressive, neuroendocrine malignancy of the skin, first described by Toker in 1972. MCC usually presents as a firm, painless, nodular, or plaque-like, flesh-colored to red-violet lesion, with a high affinity for the head and neck or upper extremities. Its most important features are represented by the acronym AEIOU: Asymptomatic/lack of tenderness, Expanding rapidly, Immune deficiency, age Older than 50 years, and UV exposure. A biopsy of a suspicious lesion is required for the diagnosis of MCC, followed by an immunopanel analysis. Diagnosis using light microscopy alone can lead to a wrong diagnosis in 60% of primary tumors and 40% of LN examinations. Immunohistochemical staining is required to exclude possible mimickers, such as small-cell lung carcinoma metastasis, lymphoma, and small-cell melanoma. Tumor cells in MCC typically express markers of neuroendocrine and epithelial differentiation, such as neuron-specific enolase (NSE), CD56, chromogranin A, synaptophysin, and low molecular weight cytokeratins (CK8, CK18, CK19, CK20), CAM 5.2, and AE1/AE3. CK20 is a diagnostic marker with high sensitivity and specificity. CK20 is positive in 80% of biopsies with characteristic membranous, punctate, and/or ‘paranuclear dot-like patterns. Expression of CK20 with the concomitant absence of TTF-1 expression is diagnostic for MCC in 90% of cases. After the diagnosis is confirmed by biopsy, a total body examination including LN evaluation for clinically detectable metastasis must be performed. The National Comprehensive Cancer Network (NCCN) guidelines recommend a systematic baseline cross-sectional imaging at diagnosis. The preferred imaging modalities are ultrasound of the locoregional LN, whole-body positron emission tomography (PET)-computed tomography (CT), or thoracic, abdomen, and pelvis CT with contrast. Occult LN metastasis can be detected in 20–40% of MCC patients, at the time of diagnosis and independently of the primary tumor size. Thus, LN status should be determined systematically at diagnosis as it is an important staging tool and an independent prognostic factor for overall survival (OS). If LN metastasis is clinically detected, imaging studies and subsequent exploratory lymphadenectomy should be performed. All other cases should undergo a sentinel lymph node biopsy (SLNB). Ideally, SLNB should be performed alongside primary tumor-wide local excision (WLE) or precede it to avoid WLE-related lymphatic drainage modifications.

• #17 Merkel cell carcinoma: epidemiology, clinical features, diagnosis and treatment of a rare disease | Anais Brasileiros de Dermatologia

  https://www.anaisdedermatologia.org.br/en-merkel-cell-carcinoma-epidemiology-clinical-articulo-S0365059623000211

  Merkel cell carcinoma is a rare skin cancer with neuroendocrine differentiation. […] Therefore, histopathology and immunohistochemistry are usually necessary. […] The North American organization National Comprehensive Cancer Network (NCCN) has proposed specific algorithms for the diagnosis of MCC, which include the following strategies: 1) A complete examination of the skin and lymph nodes; 2) Biopsy for histopathological and immunohistochemical analysis; 3) Sentinel lymph node biopsy (SLNB) for patients without clinically positive lymph nodes, preceding the excision, if possible; 4) Fine needle aspiration or lymph node biopsy for patients with clinically positive lymph nodes; consider open biopsy; 5) Imaging exams for staging as clinically indicated. […] Due to the lack of specific features and symptoms, the diagnosis becomes a challenge. Therefore, the histopathological examination by an experienced pathologist and the staining with specific immunohistochemical markers are essential in this process.

• #18 Merkel Cell Carcinoma: Symptoms, Treatment and Prognosis

  https://www.cancercenter.com/cancer-types/skin-cancer/types/merkel-cell-carcinoma

  In order to differentiate from other types of skin tumors such as melanomas, skin lymphomas or small-cell lung cancers that have metastasized into skin, the pathologist uses a technique called immunohistochemistry to detect the presence of proteins that are characteristic of Merkel cell carcinoma. […] If Merkel cell carcinoma is confirmed, the doctor may suggest additional tests to determine whether it has spread away from the original site. A care team may recommend a procedure called sentinel lymph node biopsy (SLNB) to surgically remove the lymph node closest to the primary tumor site. […] The tumor biopsy results will help determine accurate tumor staging, which is used to determine how much a tumor has developed within the body. This information helps the oncologist understand the possible future behavior of a tumor and the patient’s prognosis.

• #19 Merkel Cell Carcinoma—Update on Diagnosis, Management and Future Perspectives

  https://www.mdpi.com/2072-6694/15/1/103

  Merkel cell carcinoma (MCC) is a rare, aggressive, neuroendocrine malignancy of the skin, first described by Toker in 1972. MCC usually presents as a firm, painless, nodular, or plaque-like, flesh-colored to red-violet lesion, with a high affinity for the head and neck or upper extremities. Its most important features are represented by the acronym AEIOU: Asymptomatic/lack of tenderness, Expanding rapidly, Immune deficiency, age Older than 50 years, and UV exposure. A biopsy of a suspicious lesion is required for the diagnosis of MCC, followed by an immunopanel analysis. Diagnosis using light microscopy alone can lead to a wrong diagnosis in 60% of primary tumors and 40% of LN examinations. Immunohistochemical staining is required to exclude possible mimickers, such as small-cell lung carcinoma metastasis, lymphoma, and small-cell melanoma. Tumor cells in MCC typically express markers of neuroendocrine and epithelial differentiation, such as neuron-specific enolase (NSE), CD56, chromogranin A, synaptophysin, and low molecular weight cytokeratins (CK8, CK18, CK19, CK20), CAM 5.2, and AE1/AE3. CK20 is a diagnostic marker with high sensitivity and specificity. CK20 is positive in 80% of biopsies with characteristic membranous, punctate, and/or ‘paranuclear dot-like patterns. Expression of CK20 with the concomitant absence of TTF-1 expression is diagnostic for MCC in 90% of cases. After the diagnosis is confirmed by biopsy, a total body examination including LN evaluation for clinically detectable metastasis must be performed. The National Comprehensive Cancer Network (NCCN) guidelines recommend a systematic baseline cross-sectional imaging at diagnosis. The preferred imaging modalities are ultrasound of the locoregional LN, whole-body positron emission tomography (PET)-computed tomography (CT), or thoracic, abdomen, and pelvis CT with contrast. Occult LN metastasis can be detected in 20–40% of MCC patients, at the time of diagnosis and independently of the primary tumor size. Thus, LN status should be determined systematically at diagnosis as it is an important staging tool and an independent prognostic factor for overall survival (OS). If LN metastasis is clinically detected, imaging studies and subsequent exploratory lymphadenectomy should be performed. All other cases should undergo a sentinel lymph node biopsy (SLNB). Ideally, SLNB should be performed alongside primary tumor-wide local excision (WLE) or precede it to avoid WLE-related lymphatic drainage modifications.

• #20 Merkel Cell Carcinoma Treatment – NCI

  https://www.cancer.gov/types/skin/patient/merkel-cell-treatment-pdq

  Merkel cell carcinoma usually appears as a single painless lump on sun-exposed skin. […] Tests that examine the skin are used to diagnose Merkel cell carcinoma. […] After Merkel cell carcinoma has been diagnosed, tests are done to find out if cancer cells have spread to other parts of the body. […] 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. […] You may want to get a second opinion to confirm your Merkel cell carcinoma diagnosis and treatment plan. […] The prognosis and treatment options depend on: the stage of the cancer (the size of the tumor and whether it has spread to the lymph nodes or other parts of the body).

• #21 Merkel Cell Carcinoma of the Skin – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482329/

  Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine tumor of the skin with increasing incidence. […] Skin biopsy is diagnostic, and sentinel lymph node evaluation should be performed in all patients who are diagnosed with MCC, as the disease typically has a rapidly progressive course. […] Definitive diagnosis of MCC is made with a skin biopsy. In addition to a biopsy, a lymph node evaluation should be performed in all patients, regardless of stage. […] Those with a clinically-positive node should undergo fine needle aspiration/core biopsy, and patients without clinically-positive nodes should undergo sentinel lymph node biopsy (SLNB).

• #22 Tests for Merkel Cell Carcinoma | American Cancer Society

  https://www.cancer.org/cancer/types/merkel-cell-skin-cancer/detection-diagnosis-staging/how-diagnosed.html

  Most skin cancers, including Merkel cell carcinoma (MCC), are brought to a doctors attention because a person has noticed a change in an area of skin. […] If Merkel cell carcinoma is diagnosed, you will probably need other tests as well to learn more about it, including if it has spread. […] If the doctor thinks that a suspicious area might be Merkel cell cancer or another type of skin cancer, the area (or part of it) will be removed. This is called a skin biopsy. […] Merkel cell cancer often spreads to nearby lymph nodes, so its very important to find out if the lymph nodes contain cancer cells. […] A sentinel lymph node biopsy is a surgical procedure that is used to find the lymph nodes that are likely to be the first place Merkel cell cancer would spread to. […] If a lymph node near a Merkel cell cancer tumor is abnormally large, the doctor can use a needle biopsy to find out if the cancer has spread to that node.

• #23 Diagnosis and treatment of Merkel cell carcinoma: European consensus-based interdisciplinary guideline – Update 2022 – PubMed

  https://pubmed.ncbi.nlm.nih.gov/35732101/

  Merkel cell carcinoma (MCC) is a rare skin cancer, accounting for less than 1% of all cutaneous malignancies. […] Histopathology (small-cell neuroendocrine appearance) and immunohistochemistry (CK20 positivity and TTF-1 negativity) confirm the diagnosis. […] The current staging systems are the American Joint Committee on Cancer/Union for international Cancer control 8th edition. Baseline whole body imaging is encouraged to rule out regional and distant metastasis. […] Sentinel lymph node biopsy is recommended in all patients with MCC without clinically detectable lymph nodes or distant metastasis. […] Adjuvant RT alone, eventually combined with complete lymph nodes dissection is proposed in case of micrometastatic nodal involvement. […] In case of macroscopic nodal involvement, the standard of care is complete lymph nodes dissection potentially followed by post-operative RT. […] Immunotherapy with anti-PD-(L)1 antibodies should be offered as first-line systemic treatment in advanced MCC.

• #24 Merkel Cell Carcinoma | Cancer Support Community

  https://www.cancersupportcommunity.org/merkel-cell-carcinoma

  The following tests may be performed to confirm the stage of the cancer. […] A doctor will remove a piece of the lymph node and examine it under a microscope. This may require surgery to get a large enough sample or if the lymph node is in a location that is more difficult to get to. Sometimes the entire lymph node may need to be removed for an accurate diagnosis. […] The sentinel node is the first lymph node that gets lymphatic drainage from the MCC tumor. It is removed during surgery and observed under a microscope to check for cancer cells. […] Some, or all, of the lymph nodes are removed during surgery. They are then observed under a microscope to check for cancer cells. […] A sample of tissue is removed from a lymph node using a wide needle. […] A sample of tissue is removed from a lymph node using a thin needle.

• #25 Merkel cell carcinoma: epidemiology, clinical features, diagnosis and treatment of a rare disease | Anais Brasileiros de Dermatologia

  https://www.anaisdedermatologia.org.br/en-merkel-cell-carcinoma-epidemiology-clinical-articulo-S0365059623000211

  Cytokeratin 20 (CK20) and neuroendocrine markers such as chromogranin A, synaptophysin, CD56, neuron-specific enolase, and neurofilaments are expressed in MCC. […] For patients with clinically negative nodes, SLND should be performed and its positivity rate ranges from 30% to 38%. […] The use of imaging exams for the diagnostic investigation of patients with MCC is still under discussion. […] Gupta et al. have shown that computed tomography has low sensitivity, around 20%, for detecting lymph node metastases and low specificity for distant metastases. […] PET-CT has been extensively assessed in patients with MCC.

• #26 Tests for Merkel Cell Carcinoma | American Cancer Society

  https://www.cancer.org/cancer/types/merkel-cell-skin-cancer/detection-diagnosis-staging/how-diagnosed.html

  Most skin cancers, including Merkel cell carcinoma (MCC), are brought to a doctors attention because a person has noticed a change in an area of skin. […] If Merkel cell carcinoma is diagnosed, you will probably need other tests as well to learn more about it, including if it has spread. […] If the doctor thinks that a suspicious area might be Merkel cell cancer or another type of skin cancer, the area (or part of it) will be removed. This is called a skin biopsy. […] Merkel cell cancer often spreads to nearby lymph nodes, so its very important to find out if the lymph nodes contain cancer cells. […] A sentinel lymph node biopsy is a surgical procedure that is used to find the lymph nodes that are likely to be the first place Merkel cell cancer would spread to. […] If a lymph node near a Merkel cell cancer tumor is abnormally large, the doctor can use a needle biopsy to find out if the cancer has spread to that node.

• #27 Merkel Cell Carcinoma of the Skin – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482329/

  Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine tumor of the skin with increasing incidence. […] Skin biopsy is diagnostic, and sentinel lymph node evaluation should be performed in all patients who are diagnosed with MCC, as the disease typically has a rapidly progressive course. […] Definitive diagnosis of MCC is made with a skin biopsy. In addition to a biopsy, a lymph node evaluation should be performed in all patients, regardless of stage. […] Those with a clinically-positive node should undergo fine needle aspiration/core biopsy, and patients without clinically-positive nodes should undergo sentinel lymph node biopsy (SLNB).

• #28 Merkel cell carcinoma – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/merkel-cell-carcinoma/diagnosis-treatment/drc-20351036

  Merkel cell carcinoma diagnosis often starts with an exam. A healthcare professional may look at your skin and remove a sample of cells for testing. This skin cancer may be hard to diagnose because it may look like other skin growths. […] A biopsy is a procedure to remove a sample of tissue for testing in a lab. For Merkel cell carcinoma, a healthcare professional may use a tool to cut away some of the concerning skin. Other ways to do a skin biopsy involve using a shaving tool or a circular cutting tool to get some of the skin. The sample is tested in a lab to see if it is cancer. […] Your healthcare professional may use other tests to find out whether the cancer has spread beyond your skin. These other tests may include: […] A sentinel node biopsy is a procedure to see whether cancer has spread to the lymph nodes. This procedure involves putting a dye into the skin near the cancer. The dye then flows through the lymphatic system to the lymph nodes. […] Imaging tests used to look for signs that the cancer has spread include a chest X-ray, a CT scan of the chest and belly, and a positron emission tomography scan, also called a PET scan. […] For Merkel cell carcinoma, questions might include: What tests do I need?

• #29 Diagnosis – Merkel cell carcinoma – Cancer Institutes | Northwell Health

  https://cancer.northwell.edu/cancer-care/merkel-cell-carcinoma/diagnosis

  If the cancer is thought to have metastasized and moved to other parts of your body, a range of imaging tests may be ordered: […] CT or CAT scan (computerized axial tomography): This procedure uses multiple X-rays taken from different angles and sophisticated software to construct a very precise, two-dimensional image slice of the patient. […] MRI (magnetic resonance imaging): A powerful magnet, radio waves and computer imaging combine to create highly detailed images of the soft tissues and organs in the body. […] PET scan (positron emission tomography): Small, safe amounts of a radioactive sugar are injected into the bloodstream to highlight cancers and areas of infection and inflammation. […] X-rays: X-rays may be used to see if the cancer has spread to the bones.

• #30 Diagnosis and treatment of Merkel cell carcinoma: European consensus-based interdisciplinary guideline – Update 2022 – PubMed

  https://pubmed.ncbi.nlm.nih.gov/35732101/

  Merkel cell carcinoma (MCC) is a rare skin cancer, accounting for less than 1% of all cutaneous malignancies. […] Histopathology (small-cell neuroendocrine appearance) and immunohistochemistry (CK20 positivity and TTF-1 negativity) confirm the diagnosis. […] The current staging systems are the American Joint Committee on Cancer/Union for international Cancer control 8th edition. Baseline whole body imaging is encouraged to rule out regional and distant metastasis. […] Sentinel lymph node biopsy is recommended in all patients with MCC without clinically detectable lymph nodes or distant metastasis. […] Adjuvant RT alone, eventually combined with complete lymph nodes dissection is proposed in case of micrometastatic nodal involvement. […] In case of macroscopic nodal involvement, the standard of care is complete lymph nodes dissection potentially followed by post-operative RT. […] Immunotherapy with anti-PD-(L)1 antibodies should be offered as first-line systemic treatment in advanced MCC.

• #31 Merkel Cell Carcinoma: Symptoms, Causes, Stages & Treatment

  https://my.clevelandclinic.org/health/diseases/17971-merkel-cell-carcinoma

  You may get one or more of these tests to determine the cancer stage of Merkel cell carcinoma: CT scan, Positron emission tomography (PET) scan, Sentinel node biopsy or needle biopsy. […] Treatments for Merkel cell carcinoma depend on the cancer stage. Early-stage Merkel cell carcinoma (stages 0 to II [2]) responds better to treatments than late-stage (stages III and IIIV [3 and 4]) cancers. […] After surgery, you may need reconstructive surgery or a skin graft to repair and heal the treated area. You may also get cancer treatments to kill any lingering cancer cells in your body, such as chemotherapy, immunotherapy, or radiation therapy. […] Merkel cell carcinoma often returns after treatment. You may need to see your healthcare provider every three to four months for the first several years and get imaging scans to check for cancer recurrence. […] It’s important to see your healthcare provider any time you notice changes to your skin. They’ll remove the tumor surgically and offer other treatments depending on the cancer stage. You’ll need regular follow-ups after treatment to check for cancer recurrence and spread.

• #32 Merkel cell carcinoma – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/merkel-cell-carcinoma/diagnosis-treatment/drc-20351036

  Merkel cell carcinoma diagnosis often starts with an exam. A healthcare professional may look at your skin and remove a sample of cells for testing. This skin cancer may be hard to diagnose because it may look like other skin growths. […] A biopsy is a procedure to remove a sample of tissue for testing in a lab. For Merkel cell carcinoma, a healthcare professional may use a tool to cut away some of the concerning skin. Other ways to do a skin biopsy involve using a shaving tool or a circular cutting tool to get some of the skin. The sample is tested in a lab to see if it is cancer. […] Your healthcare professional may use other tests to find out whether the cancer has spread beyond your skin. These other tests may include: […] A sentinel node biopsy is a procedure to see whether cancer has spread to the lymph nodes. This procedure involves putting a dye into the skin near the cancer. The dye then flows through the lymphatic system to the lymph nodes. […] Imaging tests used to look for signs that the cancer has spread include a chest X-ray, a CT scan of the chest and belly, and a positron emission tomography scan, also called a PET scan. […] For Merkel cell carcinoma, questions might include: What tests do I need?

• #33 Diagnosis – Merkel cell carcinoma – Cancer Institutes | Northwell Health

  https://cancer.northwell.edu/cancer-care/merkel-cell-carcinoma/diagnosis

  If the cancer is thought to have metastasized and moved to other parts of your body, a range of imaging tests may be ordered: […] CT or CAT scan (computerized axial tomography): This procedure uses multiple X-rays taken from different angles and sophisticated software to construct a very precise, two-dimensional image slice of the patient. […] MRI (magnetic resonance imaging): A powerful magnet, radio waves and computer imaging combine to create highly detailed images of the soft tissues and organs in the body. […] PET scan (positron emission tomography): Small, safe amounts of a radioactive sugar are injected into the bloodstream to highlight cancers and areas of infection and inflammation. […] X-rays: X-rays may be used to see if the cancer has spread to the bones.

• #34 Diagnosis – Merkel cell carcinoma – Cancer Institutes | Northwell Health

  https://cancer.northwell.edu/cancer-care/merkel-cell-carcinoma/diagnosis

  If the cancer is thought to have metastasized and moved to other parts of your body, a range of imaging tests may be ordered: […] CT or CAT scan (computerized axial tomography): This procedure uses multiple X-rays taken from different angles and sophisticated software to construct a very precise, two-dimensional image slice of the patient. […] MRI (magnetic resonance imaging): A powerful magnet, radio waves and computer imaging combine to create highly detailed images of the soft tissues and organs in the body. […] PET scan (positron emission tomography): Small, safe amounts of a radioactive sugar are injected into the bloodstream to highlight cancers and areas of infection and inflammation. […] X-rays: X-rays may be used to see if the cancer has spread to the bones.

• #35 Skin cancer types: Merkel cell carcinoma diagnosis & treatment

  https://www.aad.org/public/diseases/skin-cancer/types/common/merkel-cell/treatment

  If the dermatopathologist finds MCC, your doctor may recommend that you have a surgery called a sentinel lymph node biopsy (SLNB) or a procedure called a fine needle aspiration biopsy. These biopsies can tell your doctor whether the cancer has spread to the nearest lymph nodes. When MCC spreads, this is often where it travels to first. […] Your doctor may also recommend medical testing, such as magnetic resonance imaging (MRI) or positron emission tomography (PET) scan. This can tell you whether the cancer has spread. […] None of the above treats the cancer. They are used to determine the stage of your cancer. The stage tells your doctor how far the cancer has spread. […] Merkel cell carcinoma is a rare skin cancer that requires specialized knowledge to diagnose and treat.

• #36 Merkel cell carcinoma

  https://dermnetnz.org/topics/merkel-cell-carcinoma

  Merkel cell carcinoma should be considered in any tumour with „AEIOU” clinical features, which are present in about 90% of patients with the disease. […] The main test is a biopsy of the tumour. This shows characteristic Merkel cell carcinoma pathology. Immunohistochemistry can be helpful as cytokeratin-20 (CK20) is positive in up to 95% of tumours and thyroid transcription factor (TTF1) is usually negative. […] A general examination, including evaluation of local lymph nodes, and staging investigations may be arranged to determine whether the tumour has spread to other sites. […] Staging investigations may include: Sentinel node biopsy, Lymph node ultrasound scan, Imaging using X-rays, computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) scans. […] A specific Merkel cell carcinoma staging system is published by the American Joint Committee on Cancer.

• #37 Diagnosis and treatment of Merkel cell carcinoma: European consensus-based interdisciplinary guideline – Update 2022 – PubMed

  https://pubmed.ncbi.nlm.nih.gov/35732101/

  Merkel cell carcinoma (MCC) is a rare skin cancer, accounting for less than 1% of all cutaneous malignancies. […] Histopathology (small-cell neuroendocrine appearance) and immunohistochemistry (CK20 positivity and TTF-1 negativity) confirm the diagnosis. […] The current staging systems are the American Joint Committee on Cancer/Union for international Cancer control 8th edition. Baseline whole body imaging is encouraged to rule out regional and distant metastasis. […] Sentinel lymph node biopsy is recommended in all patients with MCC without clinically detectable lymph nodes or distant metastasis. […] Adjuvant RT alone, eventually combined with complete lymph nodes dissection is proposed in case of micrometastatic nodal involvement. […] In case of macroscopic nodal involvement, the standard of care is complete lymph nodes dissection potentially followed by post-operative RT. […] Immunotherapy with anti-PD-(L)1 antibodies should be offered as first-line systemic treatment in advanced MCC.

• #38 Merkel Cell Carcinoma—Update on Diagnosis, Management and Future Perspectives

  https://www.mdpi.com/2072-6694/15/1/103

  Merkel cell carcinoma (MCC) is a rare, aggressive, neuroendocrine malignancy of the skin, first described by Toker in 1972. MCC usually presents as a firm, painless, nodular, or plaque-like, flesh-colored to red-violet lesion, with a high affinity for the head and neck or upper extremities. Its most important features are represented by the acronym AEIOU: Asymptomatic/lack of tenderness, Expanding rapidly, Immune deficiency, age Older than 50 years, and UV exposure. A biopsy of a suspicious lesion is required for the diagnosis of MCC, followed by an immunopanel analysis. Diagnosis using light microscopy alone can lead to a wrong diagnosis in 60% of primary tumors and 40% of LN examinations. Immunohistochemical staining is required to exclude possible mimickers, such as small-cell lung carcinoma metastasis, lymphoma, and small-cell melanoma. Tumor cells in MCC typically express markers of neuroendocrine and epithelial differentiation, such as neuron-specific enolase (NSE), CD56, chromogranin A, synaptophysin, and low molecular weight cytokeratins (CK8, CK18, CK19, CK20), CAM 5.2, and AE1/AE3. CK20 is a diagnostic marker with high sensitivity and specificity. CK20 is positive in 80% of biopsies with characteristic membranous, punctate, and/or ‘paranuclear dot-like patterns. Expression of CK20 with the concomitant absence of TTF-1 expression is diagnostic for MCC in 90% of cases. After the diagnosis is confirmed by biopsy, a total body examination including LN evaluation for clinically detectable metastasis must be performed. The National Comprehensive Cancer Network (NCCN) guidelines recommend a systematic baseline cross-sectional imaging at diagnosis. The preferred imaging modalities are ultrasound of the locoregional LN, whole-body positron emission tomography (PET)-computed tomography (CT), or thoracic, abdomen, and pelvis CT with contrast. Occult LN metastasis can be detected in 20–40% of MCC patients, at the time of diagnosis and independently of the primary tumor size. Thus, LN status should be determined systematically at diagnosis as it is an important staging tool and an independent prognostic factor for overall survival (OS). If LN metastasis is clinically detected, imaging studies and subsequent exploratory lymphadenectomy should be performed. All other cases should undergo a sentinel lymph node biopsy (SLNB). Ideally, SLNB should be performed alongside primary tumor-wide local excision (WLE) or precede it to avoid WLE-related lymphatic drainage modifications.

• #39 Diagnosis and treatment of Merkel cell carcinoma: European consensus-based interdisciplinary guideline – Update 2022 – PubMed

  https://pubmed.ncbi.nlm.nih.gov/35732101/

  Merkel cell carcinoma (MCC) is a rare skin cancer, accounting for less than 1% of all cutaneous malignancies. […] Histopathology (small-cell neuroendocrine appearance) and immunohistochemistry (CK20 positivity and TTF-1 negativity) confirm the diagnosis. […] The current staging systems are the American Joint Committee on Cancer/Union for international Cancer control 8th edition. Baseline whole body imaging is encouraged to rule out regional and distant metastasis. […] Sentinel lymph node biopsy is recommended in all patients with MCC without clinically detectable lymph nodes or distant metastasis. […] Adjuvant RT alone, eventually combined with complete lymph nodes dissection is proposed in case of micrometastatic nodal involvement. […] In case of macroscopic nodal involvement, the standard of care is complete lymph nodes dissection potentially followed by post-operative RT. […] Immunotherapy with anti-PD-(L)1 antibodies should be offered as first-line systemic treatment in advanced MCC.

• #40 Merkel Cell Carcinoma Types, Symptoms and Diagnosis

  https://www.ahn.org/services/cancer/types/merkel-cell-carcinoma

  MCC is staged using the American Joint Committee on Cancer (AJCC) staging system, which considers the size of the tumor, the depth of invasion, the number of lymph nodes involved, and whether the cancer has spread to distant sites. […] Your treatment for Merkel cell carcinoma (MCC) will depend on the type and stage you have.

• #41 Merkel cell carcinoma | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/neuroendocrine-tumours-nets/types/merkel-cell-skin-cancer

  Many people start by seeing their GP. Your GP looks at your symptoms. They decide whether to refer you to a dermatologist. […] The main test to diagnose MCC is to take a biopsy of the area. Your dermatologist takes a sample of skin and sends it to the laboratory. A pathologist looks at it under the microscope. You usually have a biopsy under local anaesthetic, which numbs the area. […] If you have MCC, you will need to have further tests. These are to see if the cancer has spread to other parts of your body. You might have: an ultrasound scan, a CT scan or PET-CT scan, an MRI scan. […] There is a risk that MCC cells have spread to your lymph nodes so you might have tests to check these. […] Your doctor may check your lymph nodes by doing an ultrasound and taking a biopsy. Or they might do a sentinel lymph node biopsy (SLNB). The sentinel lymph nodes are the first lymph nodes the cancer can reach. During a SLNB your doctor removes the sentinel nodes and sends them to the laboratory. This is to check them for cancer cells that can only be seen under a microscope. […] To stage MCC, doctors usually use a staging system called TNM. TNM stands for tumour (T), node (N) and metastasis (M). […] The N stage describes whether the cancer has spread to the lymph nodes. […] The M stage describes whether the cancer has spread to a different part of the body.

• #42 Merkel Cell Carcinoma Treatment – NCI

  https://www.cancer.gov/types/skin/patient/merkel-cell-treatment-pdq

  Merkel cell carcinoma usually appears as a single painless lump on sun-exposed skin. […] Tests that examine the skin are used to diagnose Merkel cell carcinoma. […] After Merkel cell carcinoma has been diagnosed, tests are done to find out if cancer cells have spread to other parts of the body. […] 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. […] You may want to get a second opinion to confirm your Merkel cell carcinoma diagnosis and treatment plan. […] The prognosis and treatment options depend on: the stage of the cancer (the size of the tumor and whether it has spread to the lymph nodes or other parts of the body).

• #43 Merkel Cell Carcinoma | UCSF Department of Surgery

  https://surgery.ucsf.edu/condition/merkel-cell-carcinoma

  Tests that examine the skin are used to diagnose Merkel cell carcinoma. […] After Merkel cell carcinoma has been diagnosed, tests are done to find out if cancer cells have spread to other parts of the body. […] 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. […] The following tests and procedures may be used in the staging process: […] A pathologist views the lymph node tissue under a microscope to check for cancer cells. […] Immunohistochemistry uses antibodies to check for certain antigens (markers) in a sample of a patients cells or tissue. […] You may want to get a second opinion to confirm your Merkel cell carcinoma diagnosis and treatment plan.

• #44 Merkel cell carcinoma – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/3000356

  Diagnosis is confirmed with skin biopsy and histopathologic evaluation including immunohistochemistry. Occult metastasis is common, and sentinel lymph node biopsy and imaging are important tools for staging the disease. […] Key diagnostic factors include firm, nontender, red or pink-to-violaceous or skin-colored papule or subcutaneous nodule and rapidly growing lesion. […] 1st tests to order include biopsy and histopathologic assessment and dermoscopy. […] Tests to consider include lymph node ultrasound, whole-body PET scan, CT scan with contrast chest/abdomen/pelvis (neck), brain MRI, fine-needle aspiration or core biopsy, sentinel lymph node biopsy (SLNB), and Merkel cell polyomavirus serology. […] Emerging tests include circulating tumor DNA (ctDNA) analysis.

• #45 Early Detection and Management in Merkel Cell Carcinoma – The ASCO Post

  https://ascopost.com/video-roundtable/evolving-skin-cancer-management/early-detection-and-management-in-merkel-cell-carcinoma/

  If you have a high index of suspicion for Merkel cell carcinoma when there’s a rapidly growing lesion, please feel around the nodule to see if you can feel any other dermal nodules in the area. […] There is indication in the literature that management of these cases at an academic center does improve survival significantly. […] Because the rate is so high of metastasis, even from a small Merkel cell carcinoma, we do perform PET scans on every patient that comes in. […] As per NCCN guidelines, we typically do image patients every 3 to 6 months until their risk falls below 5%. […] We do actually have two blood tests now in which we are able to look for recurrence in a very sensitive and specific manner. […] We are now performing circulating tumor DNA every 3 months on Merkel cell carcinoma patients, and we’re able to pick up 98% of recurrences even approximately 3 months prior to it becoming apparent on a scan.

• #46 Final Diagnosis — Case 793

  https://path.upmc.edu/cases/case793/dx.html

  Merkel cells, however, cannot be identified on standard HE staining; immunohistochemistry or electron microscopy is necessary for their detection. […] The median age of diagnosis is 65 years, however, rare cases were reported to occur in children. […] Clinically, the extent of disease at presentation is the best indication of prognosis. […] The treatment of choice for Merkel cell carcinoma is wide resection of the primary site, regional lymph node dissection and radiation therapy. […] CK20 expression has been regarded as a highly sensitive and specific marker for Merkel cell carcinoma. […] Merkel cell carcinomas are known to contain genetic alterations. […] In 2008, researchers suggested a link between Merkel cell carcinoma and a new polyomavirus, named the Merkel cell polyomavirus (MCV). […] The prognostic significance of the viral load, antibody titers, and role of underlying immunosuppression are still currently being investigated.

• #47 Merkel cell carcinoma – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/3000356

  Diagnosis is confirmed with skin biopsy and histopathological evaluation including immunohistochemistry. Occult metastasis is common, and sentinel lymph node biopsy and imaging are important tools for staging the disease. […] 1st investigations to order: biopsy and histopathological assessment, dermoscopy. […] Investigations to consider: lymph node ultrasound, whole-body PET scan, CT scan with contrast chest/abdomen/pelvis (neck), brain MRI, fine needle aspiration or core biopsy, sentinel lymph node biopsy (SLNB). […] Emerging tests: Merkel cell polyomavirus serology, circulating tumour DNA (ctDNA) analysis.

• #48 Treatment and Diagnosis of Merkel Cell Disease

  https://www.dermatologytimes.com/view/treatment-and-diagnosis-of-merkel-cell-disease

  Merkel cell carcinoma may initially be misdiagnosed as a simple cyst or benign lump because of its asymptomatic appearance, but a more specific diagnosis can be made with a skin biopsy, the study reveals. […] According to researchers, a biopsy that is positive for Merkel cell carcinoma may feature things like: Polymorphic vessels, Linear vessels, Irregular vessels, Milky red areas. […] Suspicion of Merkel cell carcinoma should be followed with a full skin and lymph node examination, as well as a general history and physical examination. […] Loren E. Hernandez, a research fellow at the University of Miami Miller School of Medicine and lead author of the 2022 study says continued investigation into the diagnosis and treatment of Merkel cell carcinoma is important considering the observed increase in cases. […] Although rare, Merkel cell carcinoma’s incidence rate is increasing and it is important for dermatologists to keep this entity on their differential as it is highly aggressive and can mimic other skin pathologies, Hernandez warns.

• #49 Merkel Cell Carcinoma | Merkel Cell Skin Cancer | Diagnosis and Treatment | University of Michigan Rogel Cancer Center

  https://www.rogelcancercenter.org/skin-cancer/merkel-cell

  Merkel cell carcinoma is a rare and potentially aggressive form of skin cancer. Though the cancer can grow and spread rapidly, it is highly treatable and curable if caught in the early stages. […] Patients that have been diagnosed through a biopsy with Merkel cell carcinoma will receive a complete evaluation and exam and are staged, counseled and educated about the disease as a new patient. Each patient’s case is then discussed at a multidisciplinary tumor board conference devoted to Merkel cell carcinoma, and includes experts from dermatology, surgical oncology, radiation oncology, medical oncology, head and neck surgery, oculoplastic surgery, pathology and nursing. […] The best course of treatment and overall management for each patient is determined by this group of collaborative experts. Working closely with the patient, family and their referring doctors, we work to coordinate treatment and follow-up care close to home when possible and to minimize trips to Ann Arbor.

• #50 Merkel Cell Carcinoma Symptoms & Diagnosis | Baptist Health Miami Cancer Institute

  https://baptisthealth.net/services/cancer-care/miami-cancer-institute/our-approach/adult-cancers/skin-cancers/merkel-cell-carcinoma/symptoms-and-diagnosis

  How is Merkel cell carcinoma diagnosed? […] At Miami Cancer Institute, our internationally recognized skin cancer specialists work together across many medical disciplines (known as a multidisciplinary approach) to provide you with the most advanced screenings and comprehensive diagnostics available today all under one roof and all conveniently located in South Florida. […] For patients with Merkel cell carcinoma, they have typically already been diagnosed with the disease by their regular healthcare provider, so they come to Miami Cancer Institute for further expert evaluation and treatment. […] Miami Cancer Institute also offers convenient same-day appointments with all members of the multidisciplinary team to design and deliver a personalized, comprehensive care plan for each patient.

• #51 Merkel Cell Carcinoma | Merkel Cell Skin Cancer | Diagnosis and Treatment | University of Michigan Rogel Cancer Center

  https://www.rogelcancercenter.org/skin-cancer/merkel-cell

  Merkel cell carcinoma is a rare and potentially aggressive form of skin cancer. Though the cancer can grow and spread rapidly, it is highly treatable and curable if caught in the early stages. […] Patients that have been diagnosed through a biopsy with Merkel cell carcinoma will receive a complete evaluation and exam and are staged, counseled and educated about the disease as a new patient. Each patient’s case is then discussed at a multidisciplinary tumor board conference devoted to Merkel cell carcinoma, and includes experts from dermatology, surgical oncology, radiation oncology, medical oncology, head and neck surgery, oculoplastic surgery, pathology and nursing. […] The best course of treatment and overall management for each patient is determined by this group of collaborative experts. Working closely with the patient, family and their referring doctors, we work to coordinate treatment and follow-up care close to home when possible and to minimize trips to Ann Arbor.

• #52 Merkel Cell Carcinoma | Fred Hutchinson Cancer Center

  https://www.fredhutch.org/en/diseases/merkel-cell-carcinoma.html

  You are at the center of everything we do at Fred Hutch Cancer Center. […] We guide you every step of the way, combining our deep clinical expertise in Merkel cell carcinoma (MCC) with a commitment to meet your unique needs. […] A quick diagnosis and appropriate treatment are essential to cure this disease. Fred Hutch offers comprehensive treatment from a team of experts who specialize in MCC. […] Our experienced doctors are well known for providing innovative Merkel cell carcinoma treatments, including immunotherapy, vaccine protocols and gene therapy as well as surgery, radiation therapy and chemotherapy. […] At Fred Hutch, you receive care from a team of providers with extensive experience in your disease. […] We unite the leading researchers and cancer specialists of Fred Hutch and UW Medicine so you can take part in MCC clinical studies not available everywhere. […] Every advance in cancer treatment in recent years has come out of clinical trials. […] For some people, taking part in a clinical study may be the best treatment choice.

• #53 Diagnostic and Treatment Challenges of Merkel Cell Carcinoma: A Case Series | Consultant360

  https://www.consultant360.com/photoclinic/diagnostic-and-treatment-challenges-merkel-cell-carcinoma-case-series

  Merkel cell carcinoma (MCC) is frequently misdiagnosed by clinicians, and late diagnoses can contribute to significant morbidity and mortality. […] A sentinel lymph node biopsy (SLNB) confirmed a diagnosis of MCC, with no evidence of nodal spread of disease. […] Diagnosis is confirmed by histopathology and immune markers. […] The majority of cases express common neuroendocrine cell markers (eg, synaptophysin, chromogranin, and neurofilament), as well as cytokeratin 20. […] At the time of diagnosis, 65% of patients have skin-limited disease, 26% have nodal spread, and 8% have systemic metastasis. […] Evaluation for extracutaneous disease involves evaluation of lymph nodes, typically via physical examination and SLNB, as well as systemic evaluation via CT/magnetic resonance imaging or CT PET scan. […] Diagnosis is usually made based on pathology. […] We emphasize the need for sending specimens of excised lesions for pathologic evaluation, as early detection improves survival.

• #54 Skin Cancer – Merkel Cell Carcinoma: Practice Essentials, History of the Procedure, Problem

  https://emedicine.medscape.com/article/870538-overview

  Merkel cell carcinoma (MCC) is the eponym for primary cutaneous neuroendocrine carcinoma, a dermal neoplasm with cytoplasmic, dense-core neuroendocrine granules and keratin filaments. […] Appropriate clinical diagnosis is often delayed because of a lack of symptoms. […] Light microscopy, electron microscopy, and immunohistochemistry may be needed to confirm the diagnosis of Merkel cell carcinoma (MCC). […] The nonspecific characteristics of Merkel cell carcinoma (MCC) lead to a lengthy differential diagnosis that includes basal cell carcinoma, squamous cell carcinoma, keratoacanthoma, amelanotic melanoma, epidermal cysts, lymphoma, and metastatic carcinoma of the skin. As a result, Merkel cell carcinoma (MCC) is rarely diagnosed until biopsy is performed.

• #55 Merkel Cell Carcinoma Warning Signs and Images

  https://www.skincancer.org/skin-cancer-information/merkel-cell-carcinoma/mcc-warning-signs/

  Merkel cell carcinoma (MCC) is rare and dangerous but treatable, especially when found at an early stage. Be watchful for any new or changing lesions on your skin and look out for these warning signs. […] Diagnosis and management of Merkel cell carcinoma presents distinct challenges, including: Misdiagnosis: 56 percent of MCCs are believed to be benign when initially examined by physicians, who may mistake the tumors for cysts or infected hair follicles. […] Since MCC is a rare and aggressive cancer, delayed detection, diagnosis and treatment are especially concerning, because as the disease progresses, treatment becomes more difficult and the risk of recurrence increases.

• #56 Merkel Cell Carcinoma Warning Signs and Images

  https://www.skincancer.org/skin-cancer-information/merkel-cell-carcinoma/mcc-warning-signs/

  Merkel cell carcinoma (MCC) is rare and dangerous but treatable, especially when found at an early stage. Be watchful for any new or changing lesions on your skin and look out for these warning signs. […] Diagnosis and management of Merkel cell carcinoma presents distinct challenges, including: Misdiagnosis: 56 percent of MCCs are believed to be benign when initially examined by physicians, who may mistake the tumors for cysts or infected hair follicles. […] Since MCC is a rare and aggressive cancer, delayed detection, diagnosis and treatment are especially concerning, because as the disease progresses, treatment becomes more difficult and the risk of recurrence increases.

• #57 Merkel Cell Carcinoma: Symptoms, Treatment, and More

  https://www.verywellhealth.com/merkel-cell-carcinoma-overview-and-more-5199239

  To diagnose MCC, a physician will first perform a skin exam to look at the lesion or lump in question. […] If the lump looks suspicious, a skin biopsy will be done to make a diagnosis. During this procedure, tissue from the lump is removed and sent to a lab for analysis. A lymph node biopsy may also be needed to see if the cancer has spread. […] Imaging tests can also help determine if MCC has spread in the body, such as: […] Because Merkel cell carcinomas can mimic other skin appearances, it has a high risk of being misdiagnosed. About 56% of Merkel cell carcinomas are thought to be noncancerous when first examined. […] Treatment is much more successful if MCCs are caught early, which can be difficult when suspicious lesions are ignored or misdiagnosed. Be sure to meet with your healthcare provider as soon as possible if you suspect lump or skin appearance may be cancerous. […] Finding the Right Specialist […] Because Merkel cell carcinoma is so rare, its important to find a healthcare professional or specialist who has experience in treating this form of cancer. Look for specialists who are familiar with this disease.

• #58 Merkel Cell Carcinoma | Symptoms, Diagnosis & Treatment | MedStar Health

  https://www.medstarhealth.org/services/merkel-cell-carcinoma

  Merkel cell carcinoma is a rare type of skin cancer that can grow quickly and spread rapidly to lymph nodes and other parts of the body. […] Because this type of cancer can be aggressive, it’s important to seek care early from a team of doctors with experience in this type of carcinoma treatment. […] Here, we work as a multidisciplinary team to effectively diagnose and treat this type of carcinoma. […] Early detection significantly improves Merkel cell carcinoma survival rates, so seek care as soon as you notice a bump, freckle, or mole that looks unusual. […] This skin cancer can be challenging to diagnose which is why it’s important to seek care at a place like MedStar Health, where we regularly diagnose and treat patients with Merkel cell carcinoma. […] If you have a suspicious bump, your dermatologist will perform a thorough examination that may include:

• #59 Merkel Cell Carcinoma – EyeWiki

  https://eyewiki.org/Merkel_Cell_Carcinoma

  After the biopsy is performed, samples can be sent for detection of polyomavirus which can help aid in the diagnosis. […] Unfortunately, many patients with MCC are initially misdiagnosed as having one of the above benign pathologies and only biopsied once rapid growth over the course of weeks to months is noted, contributing to an often significant delay in time to proper diagnosis. […] Early biopsy for suspicious lesions and prompt diagnosis is of utmost importance to maximize ocular and oncologic outcomes for patients with MCC.

• #60 Azthena logo with the word Azthena

  https://www.news-medical.net/health/What-is-Merkel-Cell-Carcinoma.aspx

  Diagnostic testing includes a thorough physical examination and health history, including a full-body skin examination. […] As local spread is common, clinicians will check for additional nodules and satellite lesions and take biopsies of affected tissue. […] In some cases, diagnostic imaging may be performed to rules out regional and distant secondary malignant growths. […] MCC is categorized into 5 stages, depending on the size of the primary tumor and degree of metastasis. […] Clinical prognosis is closely linked the to the presence and location of metastases, with distant metastases predicting poorer outcomes. […] The size of the primary tumor is also predictive of prognosis, as the risk of metastatic disease correlates positively with primary tumor size. […] Data used by the American Cancer Society indicates that the 5-year survival rate for patients with only a primary tumor is 76%, falling to 53% for patients with regional metastases, and 19% for those with distant metastases.

• #61 Merkel Cell Carcinoma Types, Symptoms and Diagnosis

  https://www.ahn.org/services/cancer/types/merkel-cell-carcinoma

  Merkel cell carcinoma (MCC) is aggressive and can spread quickly. Knowing your risk factors, early detection, and treatment offer the best chance of survival. […] Early detection is key for successful treatment. […] Regular skin exams: Check your skin regularly for any changes and see a dermatologist for annual skin exams. If you are at greater risk for developing MCC, contact your doctor right away if you notice changes in your skin. […] At AHN, the diagnosis of MCC is often confirmed and treated by a multidisciplinary team of specialists, including dermatologists, pathologists, oncologists, and surgeons. […] The first step in diagnosing Merkel cell carcinoma is often a physical exam and a review of your health history. From there, we will conduct different diagnostic tests, including blood tests, biopsies, and, if needed, imaging.

• #62 Merkel Cell Carcinoma | U.S. Dermatology Partners

  https://www.usdermatologypartners.com/services/skin-cancer/merkel-cell-carcinoma/

  Diagnosing Merkel cell carcinoma typically begins with a visual inspection. When you or your dermatologist notice a concerning spot, the next step will likely be to perform a skin biopsy to examine the cells in the skin tissue. A biopsy involves removing a small section of the skin lesion and examining it under a microscope. If Merkel cell carcinoma is discovered in a skin biopsy, a staging work-up is pursued which typically involves imaging, bloodwork, and potentially the surgical sampling of a local lymph node (termed a ‘sentinel lymph node biopsy’) to assess the local region for metastatic spread. […] Regular self-skin exams to look for new or changing skin lesions performed approximately once per month, as well as annual professional skin cancer screenings, are the key to early detection and successful treatment of Merkel cell carcinoma. […] Early intervention is essential to ensure successful treatment of any skin cancer, including Merkel cell carcinoma. Regular self-checks coupled with an annual dermatologic examination will significantly reduce your risk for Merkel cell carcinoma-related death.

• #63 Early Detection and Management in Merkel Cell Carcinoma – The ASCO Post

  https://ascopost.com/video-roundtable/evolving-skin-cancer-management/early-detection-and-management-in-merkel-cell-carcinoma/

  If you have a high index of suspicion for Merkel cell carcinoma when there’s a rapidly growing lesion, please feel around the nodule to see if you can feel any other dermal nodules in the area. […] There is indication in the literature that management of these cases at an academic center does improve survival significantly. […] Because the rate is so high of metastasis, even from a small Merkel cell carcinoma, we do perform PET scans on every patient that comes in. […] As per NCCN guidelines, we typically do image patients every 3 to 6 months until their risk falls below 5%. […] We do actually have two blood tests now in which we are able to look for recurrence in a very sensitive and specific manner. […] We are now performing circulating tumor DNA every 3 months on Merkel cell carcinoma patients, and we’re able to pick up 98% of recurrences even approximately 3 months prior to it becoming apparent on a scan.

• #64 Diagnosis and treatment of Merkel cell carcinoma: European consensus-based interdisciplinary guideline – Update 2022 – PubMed

  https://pubmed.ncbi.nlm.nih.gov/35732101/

  Merkel cell carcinoma (MCC) is a rare skin cancer, accounting for less than 1% of all cutaneous malignancies. […] Histopathology (small-cell neuroendocrine appearance) and immunohistochemistry (CK20 positivity and TTF-1 negativity) confirm the diagnosis. […] The current staging systems are the American Joint Committee on Cancer/Union for international Cancer control 8th edition. Baseline whole body imaging is encouraged to rule out regional and distant metastasis. […] Sentinel lymph node biopsy is recommended in all patients with MCC without clinically detectable lymph nodes or distant metastasis. […] Adjuvant RT alone, eventually combined with complete lymph nodes dissection is proposed in case of micrometastatic nodal involvement. […] In case of macroscopic nodal involvement, the standard of care is complete lymph nodes dissection potentially followed by post-operative RT. […] Immunotherapy with anti-PD-(L)1 antibodies should be offered as first-line systemic treatment in advanced MCC.

• #65 Merkel Cell Carcinoma—Update on Diagnosis, Management and Future Perspectives

  https://www.mdpi.com/2072-6694/15/1/103

  Merkel cell carcinoma (MCC) is a rare, aggressive, neuroendocrine malignancy of the skin, first described by Toker in 1972. MCC usually presents as a firm, painless, nodular, or plaque-like, flesh-colored to red-violet lesion, with a high affinity for the head and neck or upper extremities. Its most important features are represented by the acronym AEIOU: Asymptomatic/lack of tenderness, Expanding rapidly, Immune deficiency, age Older than 50 years, and UV exposure. A biopsy of a suspicious lesion is required for the diagnosis of MCC, followed by an immunopanel analysis. Diagnosis using light microscopy alone can lead to a wrong diagnosis in 60% of primary tumors and 40% of LN examinations. Immunohistochemical staining is required to exclude possible mimickers, such as small-cell lung carcinoma metastasis, lymphoma, and small-cell melanoma. Tumor cells in MCC typically express markers of neuroendocrine and epithelial differentiation, such as neuron-specific enolase (NSE), CD56, chromogranin A, synaptophysin, and low molecular weight cytokeratins (CK8, CK18, CK19, CK20), CAM 5.2, and AE1/AE3. CK20 is a diagnostic marker with high sensitivity and specificity. CK20 is positive in 80% of biopsies with characteristic membranous, punctate, and/or ‘paranuclear dot-like patterns. Expression of CK20 with the concomitant absence of TTF-1 expression is diagnostic for MCC in 90% of cases. After the diagnosis is confirmed by biopsy, a total body examination including LN evaluation for clinically detectable metastasis must be performed. The National Comprehensive Cancer Network (NCCN) guidelines recommend a systematic baseline cross-sectional imaging at diagnosis. The preferred imaging modalities are ultrasound of the locoregional LN, whole-body positron emission tomography (PET)-computed tomography (CT), or thoracic, abdomen, and pelvis CT with contrast. Occult LN metastasis can be detected in 20–40% of MCC patients, at the time of diagnosis and independently of the primary tumor size. Thus, LN status should be determined systematically at diagnosis as it is an important staging tool and an independent prognostic factor for overall survival (OS). If LN metastasis is clinically detected, imaging studies and subsequent exploratory lymphadenectomy should be performed. All other cases should undergo a sentinel lymph node biopsy (SLNB). Ideally, SLNB should be performed alongside primary tumor-wide local excision (WLE) or precede it to avoid WLE-related lymphatic drainage modifications.

• #66 Merkel Cell Carcinoma Treatment – NCI

  https://www.cancer.gov/types/skin/patient/merkel-cell-treatment-pdq

  There are different types of treatment for people with Merkel cell carcinoma. […] Treatment for Merkel cell carcinoma may cause side effects. […] Follow-up care may be needed. […] Treatment of stage I and stage II Merkel cell carcinoma may include: surgery to remove the tumor, such as wide local excision with or without lymph node dissection. […] Treatment of stage III Merkel cell carcinoma may include: wide local excision with or without lymph node dissection, radiation therapy, chemotherapy and immunotherapy with an immune checkpoint inhibitor (pembrolizumab), for tumors that cannot be removed by surgery. […] Treatment of stage IV Merkel cell carcinoma may include: immunotherapy with an immune checkpoint inhibitor (avelumab, pembrolizumab, or retifanlimab), chemotherapy, surgery, or radiation therapy as palliative treatment to relieve symptoms and improve quality of life.

• #67 Merkel Cell Carcinoma | Merkel Cell Skin Cancer | Diagnosis and Treatment | University of Michigan Rogel Cancer Center

  https://www.rogelcancercenter.org/skin-cancer/merkel-cell

  Treatment usually includes surgery to remove the tumor and biopsy of a lymph node (called a sentinel lymph node biopsy) to find out whether the cancer has spread. This is typically done under general anesthesia on an outpatient basis. Radiation therapy to the skin and/or lymph nodes may also be indicated for patients who have high-risk lesions. Patients whose cancer has spread beyond their lymph nodes into their organs may need systemic therapy. No matter the treatment, U-M’s Merkel cell specialists and medical team are dedicated to giving patients the highest level of care available, delivering it with compassion and taking into account your and your family’s needs. […] Once treatment is complete, you will continue to receive follow-up care through the Multidisciplinary Cutaneous Oncology Program. This will include exams of the skin and lymph nodes, and may include further testing.

• #68 Diagnosis and Treatment of Merkel Cell Carcinoma in Specialized Dermatology Units: A Clinical Practice Guideline of the Spanish Academy of Dermatology and Venereology | Actas Dermo-Sifiliográficas

  https://www.actasdermo.org/en-diagnosis-treatment-merkel-cell-carcinoma-articulo-S1578219019301696

  In patients with MCC and clinically negative nodes, SLN biopsy should be performed whenever possible and be followed by lymph node dissection if the result is positive. […] There is no evidence to support any particular follow-up schedules after treatment of a primary MCC. Follow-up should be more intensive, i.e., with more frequent visits, for the first 2 to 3 years and longer in patients with more advanced disease or a higher risk of recurrence. […] Physical examination of the full skin surface, the area around the primary tumor, and superficial lymph nodes should be performed at each visit.

• #69 Early Detection and Management in Merkel Cell Carcinoma – The ASCO Post

  https://ascopost.com/video-roundtable/evolving-skin-cancer-management/early-detection-and-management-in-merkel-cell-carcinoma/

  If you have a high index of suspicion for Merkel cell carcinoma when there’s a rapidly growing lesion, please feel around the nodule to see if you can feel any other dermal nodules in the area. […] There is indication in the literature that management of these cases at an academic center does improve survival significantly. […] Because the rate is so high of metastasis, even from a small Merkel cell carcinoma, we do perform PET scans on every patient that comes in. […] As per NCCN guidelines, we typically do image patients every 3 to 6 months until their risk falls below 5%. […] We do actually have two blood tests now in which we are able to look for recurrence in a very sensitive and specific manner. […] We are now performing circulating tumor DNA every 3 months on Merkel cell carcinoma patients, and we’re able to pick up 98% of recurrences even approximately 3 months prior to it becoming apparent on a scan.

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