Merkel Cell Carcinoma Vs. Squamous Cell Carcinoma

Merkel Cell Carcinoma Vs. Squamous Cell Carcinoma

Merkel cells are receptors formed of neuroendocrine cells which are connected by nerve endings and these take the sensation of touch and vibration to the brain and are located in the epidermis[1].

Squamous cells are flat cells of epithelial origin forming the outermost and uppermost layer of skin and even epidermis. These are keratin containing cells which perform the function of protecting the body against traumas and abrasions by maintaining its continuity.

Merkel Cell Carcinoma Vs. Squamous Cell Carcinoma

The unrestricted overgrowth of both the cells due to various factors leads to their respective cancers. Squamous cell cancers are much more common than Merkel cell cancer. Squamous cell carcinoma makes 20% 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[2]. It is associated with other skin cancers and found in multiple cancer syndromes of skin.

These cancers differ very much in their presentation and signs. Merkel cell carcinoma usually presents as nodule of small size on the skin especially of head and neck regions with a property of changing colors like blue, purple, red, etc. whereas squamous cell carcinoma presents as a shallow ulcerative lesion with elevated margins and presence of plaques marks its configuration.

The factors responsible for both cancers are nearly the same. Prolonged exposure to the sunlight, in particular, the ultraviolet rays is the risk and etiological factor for the skin cancers. Very high-grade exposure to the sunlight for long periods can lead to squamous cell carcinoma but on the other hand, low-intensity exposure of, for long periods can lead to Merkel cell carcinoma. The UV rays can lead to mutations in the genetics of the skin cells and the commonly encountered 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.

Various immune system defects like inability to do DNA repair in the skin cells known as xeroderma pigmentosum can also lead to accumulation of the mutations in the cells which can trigger the squamous cell carcinoma far more often than Merkel cell carcinoma which is relatively very rare with it.

Exposure to the ionizing radiation such as X rays, Gamma rays, etc. can easily propel these mutations in the cells and it could lead to cancerous growth. Immunosuppression is also an etiological factor for the triggering of the skin cancer. Since there is more of the incidence of squamous cell carcinoma than the Merkel cell carcinoma, these factors are found commonly associated with squamous cell cancers.

Both the cancers have their treatment of choice is surgical resection of the lesion but the lesion of squamous carcinoma requires more margins to be resected due to ulcerative presentation whereas Merkel cell carcinoma is associated more often with lymph node dissection due to higher metastatic rate. Moh’s microsurgery is performed in both cancers.

Although both can be metastatic in nature but Merkel cell cancer is more metastatic and is associated with a poorer prognosis than the squamous carcinoma. The chances of treatment and survival are more in squamous cell carcinoma.

Conclusion

The squamous cell cancers are having a much larger number of cases than Merkel cell cancer because of the strong association with etiological factors. Merkel cell carcinoma is reported in lesser number than squamous cell carcinoma because of the difference in presentation. Merkel cell carcinoma looks like a nodule on presentation which is lesser threatening to a common man whereas squamous cell carcinoma presents as an ulcerative lesion which appears far more dangerous and threatening to cause patients to report early and more frequently. It is important to know that both are lethal and both are to be reported. No nodule or ulcer is to be taken lightly because of their looks since these could become more than bothersome for the patients.

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