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Merkel Cell Carcinoma: Need for Timely Diagnosis and Treatment

By: Melissa E. Fryman, MS
Posted: Wednesday, December 12, 2018

Timely diagnosis and a multidisciplinary treatment approach can result in successful treatment of rapidly progressing, metastatic Merkel cell carcinoma. Although rare, this cutaneous neuroendocrine tumor does not have defining clinical features and can be fatal, which necessitates vigilance on the part of physicians to rule out or diagnose the disease. Andrew J. Krispinsky, MD, and Susan Massick, MD, of The Ohio State University College of Medicine, Columbus, share a case study as well as their thoughts on treating Merkel cell carcinoma in the American Journal of Medicine.

In their case report, a man presented with a 4-month history of a rapidly enlarging (2.3 x 2 cm), firm, erythematous, bleeding tumor of the scalp. He received differential diagnoses of basal cell carcinoma, melanoma, squamous cell carcinoma, keratoacanthoma, and atypical fibroxanthoma before pathologic analysis of a biopsy sample revealed the diagnosis of Merkel cell carcinoma.

Following diagnosis, the patient was referred to otolaryngology, where he underwent wide excision, sentinel lymph node biopsy, and subsequent dissection of the suboccipital and select neck lymph nodes. Upon aggressive local recurrence and nodal metastasis, a multidisciplinary tumor board recommended radiation with adjuvant therapy using the anti–PD-1 antibody pembrolizumab. After 8 cycles of pembrolizumab, the patient showed signs of clinical improvement, and he continues to be closely monitored.

“Prompt referral for an evaluation is advised, so that patients can obtain a timely diagnosis and treatment. In patients with advanced disease, a multidisciplinary approach increases the opportunities for successful treatment,” concluded the authors. 



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