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Clinical Predictors of Merkel Cell Carcinoma: Ulceration and Hyperkeratosis

By: Sarah Campen, PharmD
Posted: Thursday, January 17, 2019

The presence of ulceration and/or hyperkeratosis in Merkel cell carcinoma tumors may allow the prediction of Merkel cell polyomavirus status and morphology, according to a retrospective study by Kotaro Nagase, MD, PhD, of the Division of Dermatology at Saga University, Japan. They found that the presence of ulceration/hyperkeratosis predicted the presence of Merkel cell polyomavirus–negative Merkel cell carcinoma (80% of cases) and combined Merkel cell carcinoma (50% of cases).

“Ulceration and hyperkeratosis are inherent clinical features of [Merkel cell carcinoma] itself rather than simply mechanical disruption,” explained Dr. Nagase and colleagues. Their study was published in The Journal of Dermatology.

Patients with Merkel cell carcinoma, the highly aggressive neuroendocrine carcinoma of the skin that is associated with Merkel cell polyomavirus, often have tumors that lack characteristics to predict Merkel cell polyomavirus status and morphology. In this rare malignancy, there are two morphologic types: pure or combined, with the latter including Merkel cell carcinoma that co-occurs with non-Merkel cell carcinoma tumors.

Half of the 20 study participants (n = 10) did not exhibit positive staining for Merkel cell polyomavirus; all of the patients with Merkel cell polyomavirus–negative disease had ulceration and/or hyperkeratosis, including 3 cases of ulceration and hyperkeratosis, 5 cases of ulceration, and 2 cases of hyperkeratosis. All cases of combined disease (n = 10) also had ulceration/hyperkeratosis. In contrast, all 10 cases (50%) of Merkel cell polyomavirus–positive disease had smooth skin with the absence of ulceration and hyperkeratosis.

“Further studies are needed to validate the diagnostic and/or prognostic significance of ulcerated/keratotic lesions,” concluded Dr. Nagase and colleagues.

Disclosure: The study authors’ disclosure information may be found at

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