Merkel cell cancer natural history
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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] Ahmad Al Maradni, M.D. [3]
Overview
Merkel cell cancer is an aggressive cutaneous cancer that grows very rapidly. Merkel cell cancer usually metastasizes first to regional lymph nodes. Merkel cell cancer is a highly aggressive tumor with a mortality rate that approaches 30% to 40% within 3 years of diagnosis.
Natural History, Complications, and Prognosis
Natural History
- Merkel cell cancer is an aggressive cutaneous tumor that grows rapidly.
- Merkel cell cancer usually metastasizes to:
Complications
Common complications of merkel cell carcinoma include:[1]
- Neurologic complications which include:[2]
- Seizures
- Bilateral radiculopathies
- Myoclonus
- Cauda equina syndrome
- Altered mental status
- Leptomeningeal carcinomatosis
Prognosis
- Merkel cell cancer is a highly aggressive tumor with a mortality rate that approaches 30% to 40% within 3 years of diagnosis.
- If diagnosed early, merkel cell carcinoma has a good prognosis with a 5-year survival rate of approximately 90%.
- The prognosis depend on the following:[3][4][5][6]
- Stage at diagnosis (1st most potent prognostic factor).
- Lymph node involvement (2nd most important prognostic factor).
- Merkel cell polyomavirus (MCPyV) viral load also play an significant role in prognosis of merkel cell cancer.
- Cancer location
- Cancer depth
- Primary vs recurrent
- Lymphovascular invasion in merkel cell cancer patients associated with poor prognosis.
- Intratumoral lymphocyte infiltration in merkel cell cancer patients associated with good prognosis due to presence of CD8+ lymphocyte infiltration.[7]
- p63 expression in merkel cell cancer patients associated with poor prognosis.
References
- ↑ 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.
- ↑ Snodgrass SM, Landy H, Markoe AM, Feun L (1994). "Neurologic complications of Merkel cell carcinoma". J. Neurooncol. 22 (3): 231–4. PMID 7760100.
- ↑ Andea AA, Coit DG, Amin B, Busam KJ (November 2008). "Merkel cell carcinoma: histologic features and prognosis". Cancer. 113 (9): 2549–58. doi:10.1002/cncr.23874. PMID 18798233.
- ↑ Paulson KG, Iyer JG, Tegeder AR, Thibodeau R, Schelter J, Koba S, Schrama D, Simonson WT, Lemos BD, Byrd DR, Koelle DM, Galloway DA, Leonard JH, Madeleine MM, Argenyi ZB, Disis ML, Becker JC, Cleary MA, Nghiem P (April 2011). "Transcriptome-wide studies of merkel cell carcinoma and validation of intratumoral CD8+ lymphocyte invasion as an independent predictor of survival". J. Clin. Oncol. 29 (12): 1539–46. doi:10.1200/JCO.2010.30.6308. PMC 3082974. PMID 21422430.
- ↑ Sihto H, Böhling T, Kavola H, Koljonen V, Salmi M, Jalkanen S, Joensuu H (May 2012). "Tumor infiltrating immune cells and outcome of Merkel cell carcinoma: a population-based study". Clin. Cancer Res. 18 (10): 2872–81. doi:10.1158/1078-0432.CCR-11-3020. PMID 22467679.
- ↑ Paulson KG, Iyer JG, Simonson WT, Blom A, Thibodeau RM, Schmidt M, Pietromonaco S, Sokil M, Warton EM, Asgari MM, Nghiem P (October 2014). "CD8+ lymphocyte intratumoral infiltration as a stage-independent predictor of Merkel cell carcinoma survival: a population-based study". Am. J. Clin. Pathol. 142 (4): 452–8. doi:10.1309/AJCPIKDZM39CRPNC. PMC 4174450. PMID 25239411.
- ↑ Fields RC, Busam KJ, Chou JF, Panageas KS, Pulitzer MP, Allen PJ, Kraus DH, Brady MS, Coit DG (September 2011). "Five hundred patients with Merkel cell carcinoma evaluated at a single institution". Ann. Surg. 254 (3): 465–73, discussion 473–5. doi:10.1097/SLA.0b013e31822c5fc1. PMID 21865945.