Treatment of a Patient with Merkel Cell Skin Carcinoma Using Radiation Therapy - A Case Report

Authors

  • Andrej Petrov Acibadem Sistina Hospital, Skopje; Faculty of Medical Sciences, University Goce Delchev, Shtip
  • Slavica Kraleva Acibadem Sistina Hospital, Skopje
  • Katerina Kubelka-Sabit Acibadem Sistina Hospital, Skopje
  • Deva Petrova Acibadem Sistina Hospital, Skopje

DOI:

https://doi.org/10.3889/oamjms.2018.120

Keywords:

Carcinoma, Merkel cell, Radiotherapy

Abstract

BACKGROUND: Merkel cell carcinoma (MCC) is a rare, very aggressive tumour. The pathogenesis remains unclear, but UV radiation, immunosuppression, and the presence of Merkel cell polyomavirus in the tumour genome appear to have a key role. Merkel cell carcinoma is a highly aggressive tumour that often has a lethal end.

CAS REPORT: A patient at 93 years of age comes for an examination by a dermatologist due to a rapidly growing nodular tumour growth in the forehead area. A tumour was about 3 cm in size. It had no signs of basal-cell carcinoma, no arborising vascularisation, no pigmentations on dermoscopy. Clinically, an eventual Merkel cell carcinoma was considered for the patient, but other primary skin tumours had to be excluded, as well as the possibility that regarding the patient’s age, it may be a metastatic deposit. A skin biopsy was performed, as well as H-E examination and immunohistochemical analyses (positive CD56, positivity of neuroendocrine markers synaptophysin, chromogranin) which were in favour of Merkel cell carcinoma of the skin. After setting the diagnosis, our patient was treated with therapy which led to a complete withdrawal of a tumour. However, after 3 months the patient had repeated relapse of a tumour at the same site on the forehead and metastases in the retroauricular lymph nodes bilaterally. It shows that the radiotherapy as monotherapy has a great effect on the removal of the tumour formation, but unfortunately, it has no impact on lesion recurrence. It is also compatible with the literature data.

CONCLUSION: In many adult patients, as our case suggests, radiotherapy could be a good palliative treatment opportunity that should be considered, as well as a combination of radiation therapy with other oncologic therapeutic options.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Llombart B, Requena C, Cruz J. Update on Merkel Cell Carcinoma: Epidemiology, Etiopathogenesis, Clinical Features, Diagnosis, and Staging. Actas Dermosifiliogr. 2017; 108:108-19. https://doi.org/10.1016/j.ad.2016.07.022 PMid:27770997

Saini AT, Miles BA. Merkel cell carcinoma of the head and neck: pathogenesis, current and emerging treatment options. Onco Targets Ther. 2015; 8:2157-67. PMid:26316785 PMCid:PMC4548751

Miles BA, Goldenberg D. Education Committee of the American Head and Neck Society (AHNS). Merkel cell carcinoma: Do you know your guidelines? Rev Endocr Metab Disord. 2017; 2017.

Zur Hausen A. Book of abstracts. 47.VI Congress of dermatovenereologists of Macedonia with international participation. ISBN 978-9989-37-031-1

Becker JC, Stang A, Hausen AZ, Fischer N, DeCaprio JA, Tothill RW, Lyngaa R, Hansen UK, Ritter C, Nghiem P, Bichakjian CK, Ugurel S, Schrama D. Epidemiology, biology and therapy of Merkel cell carcinoma: conclusions from the EU project IMMOMEC. Cancer Immunol Immunother. 2017. PMid:29188306

Heath M, James N, Lemos B, et al. Clinical characteristics of Merkel cell carcinoma at diagnosis in 195 patients:the AEIOU features. J Am Acad Dermatol. 2008; 58:375-381. https://doi.org/10.1016/j.jaad.2007.11.020 PMid:18280333 PMCid:PMC2335370

Heath M, Jaimes N, Lemos B, et al. Clinical characteristics of Merkel cell carcinoma at diagnosis in 195 patients: the AEIOU features. J Am Acad Dermatol. 2008; 58:375-381. https://doi.org/10.1016/j.jaad.2007.11.020 PMid:18280333 PMCid:PMC2335370

Verzì AE, Amin SM, Guitart J, Micali G. Merkel cell carcinoma: a review. G Ital Dermatol Venereol. 2015; 150(4):419-28. PMid:26224231

Banks PD, Sandhu S Gyorki DE, Johnston ML, Rischin D. Recent Insights and Advances in the Management of Merkel Cell Carcinoma. J Oncol Pract. 2016; 12(7):637-46. https://doi.org/10.1200/JOP.2016.013367 PMid:27407160

Ye-Young Rhee, Soo Hee Kim, Eun Kyung Kim, Se Hoon Kim. Merkel Cell Carcinoma Metastatic to Pleural Fluid: A Case Report. J Pathol Transl Med. 2017. https://doi.org/10.4132/jptm.2017.11.10

Wick MR.Primary lesions that may imitate metastatic tumors histologically: A selective review. Semin Diagn Pathol. 2017. pii: S0740-2570(17)30137-5.

Coggshall K, et al. Merkel cell carcinoma: An update and review. Pathogenesis, diagnosis, and staging. J Am Acad Dermatol. 2018; 78(3):433-442. https://doi.org/10.1016/j.jaad.2017.12.001 PMid:29229574

Wright GP, Holtzman MP. Surgical resection improves median overall survival with marginal improvement in long-term survival when compared with definitive radiotherapy in Merkel cell carcinoma: A propensity score matched analysis of the National Cancer Database. Am J Surg. 2017. pii: S0002-9610(17)31072-3.

Fitzgerald TL, Dennis S, Kachare SD, Vohra NA, Wong JH, Zervos EE. Dramatic increase in the incidence and mortality from Merkel cell carcinoma in the United States. Am Surg. 2015; 81:802-806. PMid:26215243

Papadiochos I, Patrikidou A, Patsatsi A, Mangoudi D, Thuau H, Vahtsevanos K. Head and neck Merkel cell carcinoma: a retrospective case series and critical literature review with emphasis on treatment and prognosis. Oral Surg Oral Med Oral Pathol Oral Radiol. 2017. pii: S2212-4403(17)31105-7.

Takenaka H, Kishimoto S, Shibaki R, Nagata M, Yasuho H. Merkel cell carcinoma with partial spontaneous regression: an immunohistochemical, ultrastructural. Amd TUNEL labeling study. Am J Dermatopathol. 1997; 19(6): 614-8. https://doi.org/10.1097/00000372-199712000-00012 PMid:9415621

Tello et al. Merkel cell carcinoma: An update and review. Current and future therapy. J Am Acad Dermatol. 2018; 78(3):445:454.

Published

2018-04-14

How to Cite

1.
Petrov A, Kraleva S, Kubelka-Sabit K, Petrova D. Treatment of a Patient with Merkel Cell Skin Carcinoma Using Radiation Therapy - A Case Report. Open Access Maced J Med Sci [Internet]. 2018 Apr. 14 [cited 2023 Feb. 4];6(4):669-72. Available from: https://oamjms.eu/index.php/mjms/article/view/oamjms.2018.120

Issue

Section

C- Case Reports