Merkel cell carcinoma – an unpleasant situation in a family medicine
Introduction: Mercel cell carcinoma (MCC) is a rare, aggressive and often lethal neuroendocrine skin cancer. The cancer of these cells was first described by Toker in 1972. It can clinically look like benign skin lesion. Removing the tumor in the family medicine is a rare report in literature.
Case report: This report describes a case of the removal MCC, the size of approximately less than 1 cm on the right wrist at an 80-year-old lady, which was initially given the clinical impression of the inflamed cyst. Immediately after the incision, it was clear that it was a solid tumor, which was then completely excised and sent to the pathologist. The result was MCC, the edge and the bottom were not removed in healthy. The patient was immediately sent for further treatment to the oncologist, but she refused further treatment. 4 years and 2 months after removal of the tumor, there are no clinical signs of local recurrence or systemic signs of progression.
Conclusion: A family doctor who works in remote rural areas, more often than others have to use surgical skills. In addition, it can encounter rare and malignant tumors, which can be resolved only with the pathologist.
Eržen D. Karcinom Merklovih celic. Onkologija : strokovni časopis za zdravnike. 2012;16(1):14-7.
Medina-Franco H, Urist MM, Fiveash J, Heslin MJ, Bland KI, Beenken SW. Multimodality treatment of Merkel cell carcinoma: case series and literature review of 1024 cases. Ann Surg Oncol. 2001;8(3):204-8. https://doi.org/10.1007/s10434-001-0204-4 https://pubmed.ncbi.nlm.nih.gov/11314935
Tello TL, Coggshall K, Yom SS, Yu SS. Merkel cell carcinoma: An update and review: Current and future therapy. J Am Acad Dermatol. 2018;78(3):445-54. https://doi.org/10.1016/j.jaad.2017.12.004 https://pubmed.ncbi.nlm.nih.gov/29229573
García-Mesa Y, García-Piqueras J, García B, Feito J, Cabo R, Cobo J, et al. Merkel cells and Meissner’s corpuscles in human digital skin display Piezo2 immunoreactivity. J Anat. 2017;231(6):978-89. https://doi.org/10.1111/joa.12688 https://pubmed.ncbi.nlm.nih.gov/28905996
Toker C. Trabecular carcinoma of the skin. Arch Dermatol. 1972;105(1):107-10. https://doi.org/10.1001/archderm.1972.01620040075020 https://pubmed.ncbi.nlm.nih.gov/5009611
Nasseri E. Merkel cell carcinoma. Can Fam Physician. 2012;58(9):967-9. https://pubmed.ncbi.nlm.nih.gov/22972727
Heath M, Jaimes N, Lemos B, Mostaghimi A, Wang LC, Peñas PF, et al. Clinical characteristics of Merkel cell carcinoma at diagnosis in 195 patients: the AEIOU features. J Am Acad Dermatol. 2008;58(3):375-81. https://doi.org/10.1016/j.jaad.2007.11.020 https://pubmed.ncbi.nlm.nih.gov/18280333
Buis PA, Verweij W, van Diest PJ. Value of histopathologic analysis of subcutis excisions by general practitioners. BMC Fam Pract. 2007;8(1):5. https://doi.org/10.1186/1471-2296-8-5 https://pubmed.ncbi.nlm.nih.gov/17257417
Bergant D, Hočevar M, Čufer T.. Karcinom Merklovih celic. Onkologija : strokovni časopis za zdravnike. 2002;9(2):63-7.
Becker JC, Stang A, DeCaprio JA, Cerroni L, Lebbé C, Veness M, et al. Merkel cell carcinoma. Nat Rev Dis Primers. 2017;3(1):17077. https://doi.org/10.1038/nrdp.2017.77 https://pubmed.ncbi.nlm.nih.gov/29072302
Duprat JP, Landman G, Salvajoli JV, Brechtbühl ER. A review of the epidemiology and treatment of Merkel cell carcinoma. Clinics (São Paulo). 2011;66(10):1817-23. https://doi.org/10.1590/S1807-59322011001000023 https://pubmed.ncbi.nlm.nih.gov/22012057
Feng H, Shuda M, Chang Y, Moore PS. Clonal integration of a polyomavirus in human Merkel cell carcinoma. Science. 2008;319(5866):1096-100. https://doi.org/10.1126/science.1152586 https://pubmed.ncbi.nlm.nih.gov/18202256
Paik JY, Hall G, Clarkson A, Lee L, Toon C, Colebatch A, et al. Immunohistochemistry for Merkel cell polyomavirus is highly specific but not sensitive for the diagnosis of Merkel cell carcinoma in the Australian population. Hum Pathol. 2011;42(10):1385-90. https://doi.org/10.1016/j.humpath.2010.12.013 https://pubmed.ncbi.nlm.nih.gov/21453956
National Comprehensive Cancer Network (NCCN). Clinical practice guidelines in oncology: Merkel cell carcinoma. 2018[cited 2018 Avg 26]. Available from: https://www.nccn.org/professionals/physician_gls/pdf/mcc.pdf
Wang TS, Byrne PJ, Jacobs LK, Taube JM. Merkel cell carcinoma: update and review. Semin Cutan Med Surg. 2011;30(1):48-56. https://doi.org/10.1016/j.sder.2011.02.001 https://pubmed.ncbi.nlm.nih.gov/21540020
Strub B, Weindel S, Witt P, Grünert J. [The interdisciplinary treatment of Merkel cell carcinoma: a retrospective case analysis and review of the current literature]. Zentralbl Chir. 2009;134(5):468-73. https://pubmed.ncbi.nlm.nih.gov/19757348
Allen PJ, Bowne WB, Jaques DP, Brennan MF, Busam K, Coit DG. Merkel cell carcinoma: prognosis and treatment of patients from a single institution. J Clin Oncol. 2005;23(10):2300-9. https://doi.org/10.1200/JCO.2005.02.329 https://pubmed.ncbi.nlm.nih.gov/15800320
Gunaratne DA, Howle JR, Veness MJ. Sentinel lymph node biopsy in Merkel cell carcinoma: a 15-year institutional experience and statistical analysis of 721 reported cases. Br J Dermatol. 2016;174(2):273-81. https://doi.org/10.1111/bjd.14240 https://pubmed.ncbi.nlm.nih.gov/26480031
Tai PT, Yu E, Winquist E, Hammond A, Stitt L, Tonita J, et al. Chemotherapy in neuroendocrine/Merkel cell carcinoma of the skin: case series and review of 204 cases. J Clin Oncol. 2000;18(12):2493-9. https://doi.org/10.1200/JCO.2000.18.12.2493 https://pubmed.ncbi.nlm.nih.gov/10856110
Iyer JG, Blom A, Doumani R, Lewis C, Tarabadkar ES, Anderson A, et al. Response rates and durability of chemotherapy among 62 patients with metastatic Merkel cell carcinoma. Cancer Med. 2016;5(9):2294-301. https://doi.org/10.1002/cam4.815 https://pubmed.ncbi.nlm.nih.gov/27431483
Kitamura N, Tomita R, Yamamoto M, Yoshizawa Y, Sasabe E, Yamada T, et al. Complete remission of Merkel cell carcinoma on the upper lip treated with radiation monotherapy and a literature review of Japanese cases. World J Surg Oncol. 2015;13(1):152. https://doi.org/10.1186/s12957-015-0564-z https://pubmed.ncbi.nlm.nih.gov/25886455
Pape E, Rezvoy N, Penel N, Salleron J, Martinot V, Guerreschi P, et al. Radiotherapy alone for Merkel cell carcinoma: a comparative and retrospective study of 25 patients. J Am Acad Dermatol. 2011;65(5):983-90. https://doi.org/10.1016/j.jaad.2010.07.043 https://pubmed.ncbi.nlm.nih.gov/21641081
Harrington C, Kwan W. Outcomes of Merkel cell carcinoma treated with radiotherapy without radical surgical excision. Ann Surg Oncol. 2014;21(11):3401-5. https://doi.org/10.1245/s10434-014-3757-8 https://pubmed.ncbi.nlm.nih.gov/25001091
Rak v Sloveniji 2014. Ljubljana: Onkološki inštitut Ljubljana, Epidemiologija in register raka, Register raka Republike Slovenije; 2017.
Zucchi S. Merkel cell carcinoma: case report and literature review, from a remote region of France. Rural Remote Health. 2009;9(1):1072. https://pubmed.ncbi.nlm.nih.gov/19206996
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