What Is The Best Treatment For Merkel Cell Carcinoma?

Merkel cell carcinoma is a tumor of both epithelial and neuroendocrine origin. Its demarcation to anyone origin has not been possible. This cancer originates from the Merkel cells which are working as a receptor for touch in the epidermis. It also takes vibratory sensations from the skin along with them. The uninhibited growth and proliferation of the cells along with the disruption of nucleocytoplasmic ratio and differentiation of the cells leads to Merkel cell cancer.

What Is The Best Treatment For Merkel Cell Carcinoma?

The best treatment and also the treatment of choice for Merkel cell cancer is surgical treatment. Surgical resection of the nodule or small tumor in stage 1 and 2 remove it completely and prevent any further growth or spreading of it. An excision margin of 2-3 cm is to be kept while removing it. It is checked microscopically by taking the part of the skin and other tissue from the edge of the resection area. Moh’s microsurgery is a similar procedure in which the tissue edges are checked for the cancerous cells itself during the procedure and if there are any tumor cells found in it then the resection is continued and biopsied again[1]. It is done till the edges of the resected area of skin are found to be cancer-free. Usually, a maximum of 2-3 times is required.

Radical neck dissection is done also for many cases on the basis of the staging of the tumor. It involves removal of many components of the neck including accessory spinal nerve, internal jugular vein, sternocleidomastoid muscle and all the groups of lymph nodes of the neck. Modified radical neck dissection is also done in some cases which are less severe and one of the two or both structures that the accessory spinal nerve and internal jugular vein are preserved[2].

The lymph nodes involved are to be removed completely along with cancer surgically. If the tumor is a metastatic one like Merkel cell cancer then the nearby lymph nodes which are draining that area are excised prophylactically to prevent its spread in the body because lymphatic drainage is the most common route of spread of cancer.

The radiotherapy is given in many cases as it is metastatic cancer and there is always risk involved the spreading to other body parts with it. Radiotherapy makes surgical treatment more successful. It could be given in various ways like used as adjuvant therapy that is after the surgery has been done, in cases where complete removal of cancer has not taken place. It is also used to irradiate the lymph nodes in the cases where lymph nodes are involved and cannot completely. In late or end stages it is used sometimes as neoadjuvant therapy to reduce or shrink the tumor size to make it surgically resectable.

If the cancer reaches the late stages and is not possible to remove whole of it or has reached a stage where all the major organs are involved, then chemotherapy with anti-cancer drugs is given which has good success of remission in many patients. Imatinib which is a tyrosine kinase inhibitor has been shown to have success in some patients. Another recombinant drug to be used in Merkel cell cancer is pembrolizumab which is a PD-1 receptor antagonist.

Conclusion

Although Merkel cell carcinoma is a rare tumor with a poor cure rate in late stages and is widely spreading when left untreated but complete cure is possible in it if detected early. Surgical resection of the cancerous nodule is the treatment of choice and performing further lymph node resection neck dissection, etc. is done in high-risk patients. Any nodule or ulcer of any size on the skin, especially of head and neck regions usually with a property of changing colors like blue, purple, red, etc., should be reported to the doctor as soon as possible and treatment should be started immediately.

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