Merkel cell cancer physical examination: Difference between revisions

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{{Merkel cell cancer}}
{{Merkel cell cancer}}
{{CMG}}; {{AE}} {{VKG}} {{JH}}; {{AAM}}
{{CMG}}; {{AE}} {{VKG}}  


==Overview==
==Overview==
Physical exam findings of [[merkel cell cancer]] include red/violaceous skin [[mass]] that appear in sun exposed areas.
Physical exam findings of merkel cell cancer include red/violaceous skin [[mass]] that appear in [[Sun exposure|sun exposed]] areas.
==Physical examination==
==Physical examination==
[[Physical examination]] of patients with [[merkel cell cancer]] is usually remarkable for flesh-colored or bluish-red, intracutaneous [[Nodule (medicine)|nodules]].
[[Physical examination]] of patients with merkel cell cancer is usually remarkable for flesh-colored or bluish-red, intracutaneous [[Nodule (medicine)|nodules]].


=== Appearance of the Patient ===
=== Appearance of the Patient ===
* [[Patient|Patients]] with [[merkel cell cancer]] usually appear normal.
* [[Patient|Patients]] with merkel cell cancer usually appear normal.


=== Vital Signs ===
=== Vital Signs ===
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=== Skin ===
=== Skin ===
* Skin examination of patients with [[merkel cell cancer]] is significant for:<ref name="pmid18280333">{{cite journal |vauthors=Heath M, Jaimes N, Lemos B, Mostaghimi A, Wang LC, Peñas PF, Nghiem P |title=Clinical characteristics of Merkel cell carcinoma at diagnosis in 195 patients: the AEIOU features |journal=J. Am. Acad. Dermatol. |volume=58 |issue=3 |pages=375–81 |date=March 2008 |pmid=18280333 |pmc=2335370 |doi=10.1016/j.jaad.2007.11.020 |url=}}</ref><ref name="pmid29085720">{{cite journal |vauthors=Geller S, Pulitzer M, Brady MS, Myskowski PL |title=Dermoscopic assessment of vascular structures in solitary small pink lesions-differentiating between good and evil |journal=Dermatol Pract Concept |volume=7 |issue=3 |pages=47–50 |date=July 2017 |pmid=29085720 |doi=10.5826/dpc.0703a10 |url=}}</ref><ref name="pmid23574613">{{cite journal |vauthors=Jalilian C, Chamberlain AJ, Haskett M, Rosendahl C, Goh M, Beck H, Keir J, Varghese P, Mar A, Hosking S, Hussain I, Rich M, McLean C, Kelly JW |title=Clinical and dermoscopic characteristics of Merkel cell carcinoma |journal=Br. J. Dermatol. |volume=169 |issue=2 |pages=294–7 |date=August 2013 |pmid=23574613 |doi=10.1111/bjd.12376 |url=}}</ref>
{| align="right"
**A mass that appear in sun exposed areas of the skin
|
**Mass that usually 1-2 cm
[[File:Merkel Cell Cancer.gif|alt=Merkel Cell Cancer|center|thumb|'''Merkel Cell Cancer''' [https://commons.wikimedia.org/wiki/File:Merkel_cell_carcinoma_arm.jpg#/media/File:Merkel_cell_carcinoma_arm.jpg Source:Wikimedia Commons]]]
**Non-tender, firm, shiny, flesh-colored or bluish-red or pink colour intracutaneous [[Nodule (medicine)|nodule]]
|}
**Presence of a polymorphous [[vascular]] pattern is very characteristic to  [[merkel cell cancer]]
* Skin examination of patients with merkel cell cancer is significant for:<ref name="pmid18280333">{{cite journal |vauthors=Heath M, Jaimes N, Lemos B, Mostaghimi A, Wang LC, Peñas PF, Nghiem P |title=Clinical characteristics of Merkel cell carcinoma at diagnosis in 195 patients: the AEIOU features |journal=J. Am. Acad. Dermatol. |volume=58 |issue=3 |pages=375–81 |date=March 2008 |pmid=18280333 |pmc=2335370 |doi=10.1016/j.jaad.2007.11.020 |url=}}</ref><ref name="pmid29085720">{{cite journal |vauthors=Geller S, Pulitzer M, Brady MS, Myskowski PL |title=Dermoscopic assessment of vascular structures in solitary small pink lesions-differentiating between good and evil |journal=Dermatol Pract Concept |volume=7 |issue=3 |pages=47–50 |date=July 2017 |pmid=29085720 |doi=10.5826/dpc.0703a10 |url=}}</ref><ref name="pmid23574613">{{cite journal |vauthors=Jalilian C, Chamberlain AJ, Haskett M, Rosendahl C, Goh M, Beck H, Keir J, Varghese P, Mar A, Hosking S, Hussain I, Rich M, McLean C, Kelly JW |title=Clinical and dermoscopic characteristics of Merkel cell carcinoma |journal=Br. J. Dermatol. |volume=169 |issue=2 |pages=294–7 |date=August 2013 |pmid=23574613 |doi=10.1111/bjd.12376 |url=}}</ref>
**A mass that appear in sun exposed areas of the skin.
**Mass that usually 1-2 cm.
**Non-tender, firm, shiny, flesh-colored or bluish-red or pink colour intracutaneous [[Nodule (medicine)|nodule]].
**Presence of a polymorphous [[vascular]] pattern is very characteristic to  merkel cell cancer.
**Dome-shaped or raised nodule
**Dome-shaped or raised nodule
**Red/violaceous skin mass
**Red/violaceous skin mass
Line 25: Line 29:
**#[[Head]] and [[neck]]
**#[[Head]] and [[neck]]
**#[[Upper limbs]](UL) and [[shoulder]]
**#[[Upper limbs]](UL) and [[shoulder]]
**#[[Lower limbs]](LL) and [[Hip (anatomy)|hip]]
**#[[Lower limbs]](LL) and [[Hip (anatomy)|hip]]  
**#[[Trunk]]
**#[[Trunk]]
[[File:Merkel cell cancer.jpg|alt=Merkel cell cancer|center|thumb|Merkel cell cancer  https://commons.wikimedia.org/wiki/File:Merkel_cell_carcinoma_arm.jpg#/media/File:Merkel_cell_carcinoma_arm.jpg]]
[[File:Merkel cell carcinoma of upper eyelid.gif|alt=Merkel Cell Carcinoma of the Eyelid and Periocular Region|center|thumb|Merkel cell carcinoma of upper eyelid- case courtesy by Helen Merritt et al <ref>{{Cite web|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4074820/|title=Merkel Cell Carcinoma of the Eyelid and Periocular Region|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>]]


=== HEENT ===
=== HEENT ===
* HEENT examination of patients with [[merkel cell cancer]] is usually shows the following:<ref name="pmid29072302">{{cite journal |vauthors=Becker JC, Stang A, DeCaprio JA, Cerroni L, Lebbé C, Veness M, Nghiem P |title=Merkel cell carcinoma |journal=Nat Rev Dis Primers |volume=3 |issue= |pages=17077 |date=October 2017 |pmid=29072302 |pmc=6054450 |doi=10.1038/nrdp.2017.77 |url=}}</ref><ref name="pmid30085832">{{cite journal |vauthors=Schmerling RA, Casas JG, Cinat G, Ospina FEG, Kassuga LEBP, Tlahuel JLM, Mazzuoccolo LD |title=Burden of Disease, Early Diagnosis, and Treatment of Merkel Cell Carcinoma in Latin America |journal=J Glob Oncol |volume= |issue=4 |pages=1–11 |date=July 2018 |pmid=30085832 |pmc=6223512 |doi=10.1200/JGO.18.00041 |url=}}</ref>
* HEENT examination of patients with [[merkel cell cancer]] is usually shows the following:<ref name="pmid29072302">{{cite journal |vauthors=Becker JC, Stang A, DeCaprio JA, Cerroni L, Lebbé C, Veness M, Nghiem P |title=Merkel cell carcinoma |journal=Nat Rev Dis Primers |volume=3 |issue= |pages=17077 |date=October 2017 |pmid=29072302 |pmc=6054450 |doi=10.1038/nrdp.2017.77 |url=}}</ref><ref name="pmid30085832">{{cite journal |vauthors=Schmerling RA, Casas JG, Cinat G, Ospina FEG, Kassuga LEBP, Tlahuel JLM, Mazzuoccolo LD |title=Burden of Disease, Early Diagnosis, and Treatment of Merkel Cell Carcinoma in Latin America |journal=J Glob Oncol |volume= |issue=4 |pages=1–11 |date=July 2018 |pmid=30085832 |pmc=6223512 |doi=10.1200/JGO.18.00041 |url=}}</ref>
** [[Mass]] measuring 2 X 3 cm most commonly in the right nasal [[Ala (anatomy)|ala]].
** [[Mass]] measuring 2 X 3 cm most commonly in the right nasal [[Ala (anatomy)|ala]].
** Due to the [[mass]] effect patients with [[merkel cell cancer]] might experience nasal obstruction.
** Due to the [[mass]] effect patients with merkel cell cancer might experience nasal obstruction.


=== Lungs ===
=== Lungs ===
* [[Pulmonary]] examination of patients with [[merkel cell cancer]] is usually normal.
* [[Pulmonary]] examination of patients with merkel cell cancer is usually normal.


=== Heart ===
=== Heart ===
* [[Circulatory system|Cardiovascular]] examination of patients with [[merkel cell cancer]] is usually normal.
* [[Circulatory system|Cardiovascular]] examination of patients with merkel cell cancer is usually normal.


=== Abdomen ===
=== Abdomen ===
* [[Abdominal]] examination of patients with [[merkel cell cancer]] is usually normal.
* [[Abdominal]] examination of patients with merkel cell cancer is usually normal.


=== Back ===
=== Back ===
* [[Human back|Back]] examination of patients with [[merkel cell cancer]] is usually normal.
* [[Human back|Back]] examination of patients with merkel cell cancer is usually normal.


=== Genitourinary ===
=== Genitourinary ===
* [[Genitourinary]] examination of patients with [[merkel cell cancer]] is usually normal.
* [[Genitourinary]] examination of patients with merkel cell cancer is usually normal.


=== Neuromuscular ===
=== Neuromuscular ===
* [[Neuromuscular]] examination of patients with [[merkel cell cancer]] shows the following:<ref name="Honeybul2016">{{cite journal|last1=Honeybul|first1=S.|title=Cerebral metastases from Merkel cell carcinoma: long-term survival|journal=Journal of Surgical Case Reports|volume=2016|issue=10|year=2016|pages=rjw165|issn=2042-8812|doi=10.1093/jscr/rjw165}}</ref><ref name="pmid11243282">{{cite journal |vauthors=Eggers SD, Salomao DR, Dinapoli RP, Vernino S |title=Paraneoplastic and metastatic neurologic complications of Merkel cell carcinoma |journal=Mayo Clin. Proc. |volume=76 |issue=3 |pages=327–30 |date=March 2001 |pmid=11243282 |doi=10.4065/76.3.327 |url=}}</ref>
* [[Neuromuscular]] examination of patients with merkel cell cancer shows the following:<ref name="Honeybul2016">{{cite journal|last1=Honeybul|first1=S.|title=Cerebral metastases from Merkel cell carcinoma: long-term survival|journal=Journal of Surgical Case Reports|volume=2016|issue=10|year=2016|pages=rjw165|issn=2042-8812|doi=10.1093/jscr/rjw165}}</ref><ref name="pmid11243282">{{cite journal |vauthors=Eggers SD, Salomao DR, Dinapoli RP, Vernino S |title=Paraneoplastic and metastatic neurologic complications of Merkel cell carcinoma |journal=Mayo Clin. Proc. |volume=76 |issue=3 |pages=327–30 |date=March 2001 |pmid=11243282 |doi=10.4065/76.3.327 |url=}}</ref>
** [[Clonus]] may be present
** [[Clonus]] may be present
** Sudden onset of severe [[headache]]
** Sudden onset of severe [[headache]]
** Gait disturbance  
** Gait disturbance  
** [[Confusion]]
** [[Confusion]]
** Brain [[metastasis]] from [[merkel cell carcinoma]]  
** Brain [[metastasis]] from merkel cell carcinoma   


=== Extremities ===
=== Extremities ===
* [[Extremities]] examination of patients with  [[merkel cell carcinoma]]  is usually normal.
* [[Extremities]] examination of patients with  merkel cell carcinoma is usually normal.
<gallery>
 
Image: Merkel_cell_tumours_01.jpeg| Merkel cell tumor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=288>
 
Image: Merkel_cell_tumours_02.jpeg| Merkel cell tumor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=288>
 
Image: Merkel cell tumour 01.jpg| Merkel cell tumor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=288>
Image: Merkel cell tumour 02.jpg| Merkel cell tumor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=288>
 
Image: Melkersson rosenthal syndrome 02.jpg| Merkel cell tumor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=288>
 
</gallery>
 
==References==
==References==
{{reflist|2}}
{{reflist|2}}

Latest revision as of 14:14, 25 March 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]

Overview

Physical exam findings of merkel cell cancer include red/violaceous skin mass that appear in sun exposed areas.

Physical examination

Physical examination of patients with merkel cell cancer is usually remarkable for flesh-colored or bluish-red, intracutaneous nodules.

Appearance of the Patient

  • Patients with merkel cell cancer usually appear normal.

Vital Signs

  • Mostly all vitals are within normal limits.

Skin

Merkel Cell Cancer
Merkel Cell Cancer Source:Wikimedia Commons
  • Skin examination of patients with merkel cell cancer is significant for:[1][2][3]
    • A mass that appear in sun exposed areas of the skin.
    • Mass that usually 1-2 cm.
    • Non-tender, firm, shiny, flesh-colored or bluish-red or pink colour intracutaneous nodule.
    • Presence of a polymorphous vascular pattern is very characteristic to merkel cell cancer.
    • Dome-shaped or raised nodule
    • Red/violaceous skin mass
    • +/- Crusting and ulceration
    • According to National Cancer Database the following are the most common locations of merkel cell cancer in decreasing order:
      1. Head and neck
      2. Upper limbs(UL) and shoulder
      3. Lower limbs(LL) and hip
      4. Trunk
Merkel Cell Carcinoma of the Eyelid and Periocular Region
Merkel cell carcinoma of upper eyelid- case courtesy by Helen Merritt et al [4]

HEENT

  • HEENT examination of patients with merkel cell cancer is usually shows the following:[5][6]
    • Mass measuring 2 X 3 cm most commonly in the right nasal ala.
    • Due to the mass effect patients with merkel cell cancer might experience nasal obstruction.

Lungs

  • Pulmonary examination of patients with merkel cell cancer is usually normal.

Heart

  • Cardiovascular examination of patients with merkel cell cancer is usually normal.

Abdomen

  • Abdominal examination of patients with merkel cell cancer is usually normal.

Back

  • Back examination of patients with merkel cell cancer is usually normal.

Genitourinary

  • Genitourinary examination of patients with merkel cell cancer is usually normal.

Neuromuscular

Extremities

  • Extremities examination of patients with merkel cell carcinoma is usually normal.

References

  1. ↑ Heath M, Jaimes N, Lemos B, Mostaghimi A, Wang LC, Peñas PF, Nghiem P (March 2008). "Clinical characteristics of Merkel cell carcinoma at diagnosis in 195 patients: the AEIOU features". J. Am. Acad. Dermatol. 58 (3): 375–81. doi:10.1016/j.jaad.2007.11.020. PMC 2335370. PMID 18280333.
  2. ↑ Geller S, Pulitzer M, Brady MS, Myskowski PL (July 2017). "Dermoscopic assessment of vascular structures in solitary small pink lesions-differentiating between good and evil". Dermatol Pract Concept. 7 (3): 47–50. doi:10.5826/dpc.0703a10. PMID 29085720.
  3. ↑ Jalilian C, Chamberlain AJ, Haskett M, Rosendahl C, Goh M, Beck H, Keir J, Varghese P, Mar A, Hosking S, Hussain I, Rich M, McLean C, Kelly JW (August 2013). "Clinical and dermoscopic characteristics of Merkel cell carcinoma". Br. J. Dermatol. 169 (2): 294–7. doi:10.1111/bjd.12376. PMID 23574613.
  4. ↑ "Merkel Cell Carcinoma of the Eyelid and Periocular Region".
  5. ↑ Becker JC, Stang A, DeCaprio JA, Cerroni L, Lebbé C, Veness M, Nghiem P (October 2017). "Merkel cell carcinoma". Nat Rev Dis Primers. 3: 17077. doi:10.1038/nrdp.2017.77. PMC 6054450. PMID 29072302.
  6. ↑ Schmerling RA, Casas JG, Cinat G, Ospina F, Kassuga L, Tlahuel J, Mazzuoccolo LD (July 2018). "Burden of Disease, Early Diagnosis, and Treatment of Merkel Cell Carcinoma in Latin America". J Glob Oncol (4): 1–11. doi:10.1200/JGO.18.00041. PMC 6223512. PMID 30085832. Vancouver style error: initials (help)
  7. ↑ Honeybul, S. (2016). "Cerebral metastases from Merkel cell carcinoma: long-term survival". Journal of Surgical Case Reports. 2016 (10): rjw165. doi:10.1093/jscr/rjw165. ISSN 2042-8812.
  8. ↑ Eggers SD, Salomao DR, Dinapoli RP, Vernino S (March 2001). "Paraneoplastic and metastatic neurologic complications of Merkel cell carcinoma". Mayo Clin. Proc. 76 (3): 327–30. doi:10.4065/76.3.327. PMID 11243282.


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