Differences Between Merkel Cell Carcinoma & Basal Cell Carcinoma

Differences Between Merkel Cell Carcinoma & Basal 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 and vibration in the epidermis.

Basal cell carcinoma is a tumor of epithelial origin with the cells involved in it are round or columnar shaped cells found in the basal layer of the epithelium. These cells usually give rise to the normal epidermis but sometimes they get mutated and can result in so-called basal cell carcinoma[1]. These are also known as rodent ulcers because of their specific presentation grossly on the skin.

Basal cell cancers are the most commonly found cancers in the whole world and are much more common than Merkel cell cancer. Basal cell carcinoma makes 80% of the total skin cancers of non-melanomatous origin whereas, on the other hand, the Merkel cell cancer is quite rare cancer to be found alone. The rest of the 20% are squamous cell carcinomas which make them the second most common skin cancer to be found.

Differences Between Merkel Cell Carcinoma & Basal Cell Carcinoma

Prolonged exposure to the sunlight, in particular, the ultraviolet rays is the biggest risk and etiological factor for the skin cancers. The UV rays can lead to mutations in the genetics of the skin cells and the most commonly found gene to be mutated is the Tp53 gene. It is a tumor suppressor gene and its suppression can lead to stimulation of oncogenes which are responsible for reducing the cell death and increasing its uninhibited proliferation rate. Exposure to the ionizing radiation such as X rays, Gamma rays, etc. and Immunosuppression is also working as triggering factors of the skin cancers.

These cancers differ very much in their presentation and signs. Merkel cell carcinoma usually presents as nodule of small size on skin especially of head and neck regions with a property of changing colours like blue, purple, red etc. whereas basal cell carcinoma presents as ulcerative lesion with rolled margins which makes its presentation like a burrow made by a rodent so as to be known as rodent ulcer. Other presentations of basal cell carcinoma include white nodule with central umbilication, bleeding on trauma, etc.

Basal cell carcinoma is more aggressive locally and destroys the local tissue extensively but very rare to spread to other areas that are least metastatic whereas Merkel cell carcinoma is not that much aggressive locally but is much more metastatic than its other counterpart. Basal cell carcinoma is very commonly known to have recurrence due to the higher risk associated with the etiological factors whereas the recurrence rate is very low in Merkel cell carcinoma.

Both Merkel cell carcinoma & basal cell carcinoma have their treatment of choice is surgical resection of the lesion. Moh’s microsurgery is performed in both the cancers to make sure that the edges of the lesion are free from the cancerous cells. Basal cell carcinoma’s special property of being only locally aggressive and less metastatic makes it more favorable to the treatment by surgical resection. It also makes most commonly curable skin cancer in the world in comparison to Merkel cell carcinoma which has a relatively poorer prognosis.

Conclusion

Basal cell carcinomas are the most common cancer with cases as much as 80% but are also the most curable group of carcinomas. It also has a high recurrence rate than Merkel cell carcinoma but repeated surgeries can be easily performed for the treatment and curative even in recurrence.

Chemotherapy with recombinant anticancer drugs is needed in later stages of the Merkel cell carcinoma like imatinib, pembrolizumab, etc. It is more or less needed in basal cell carcinoma due to the high success of the surgery. Basal cell cancers are easily treatable when detected early and resection is relatively very easy and safe with minimum damage to the face beauty. The approach by the patient for the treatment in the early phases is the only basic requirement.

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