Merkel Cell Carcinoma Treatment (PDQ®)–Health Professional Version

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Changes to This Summary (09/12/2018)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

General Information About Merkel Cell Carcinoma (MCC)

Added text to state that MCC is the second most common cause of skin cancer death after melanoma (cited Agelli et al. and Harms as references 3 and 4, respectively).

Added text to state that therapeutic options have been historically limited for patients with advanced disease; however, new immunotherapeutic approaches are associated with durable responses (cited Cassler et al. as reference 12).

Added text about the incidence of MCC in the United States and possible factors related to its rise (cited Paulson et al. as reference 20). Also added text about higher incidence in immunosuppressed populations (cited Ma et al. as reference 21).

Added text about significant prognostic factors for MCC (cited Harms et al., Iyer et al., Schwartz et al., and Ko et al. as references 59, 60, 61, and 62, respectively).

Stage Information for MCC

Editorial changes were made to this section.

Treatment Option Overview

Added Immunotherapy as a new subsection.

Stage I and II MCC Treatment

Added text to state that excision with 1 cm to 2 cm margins and radiation therapy are the mainstays of management for primary MCC tumors. Adjuvant radiation therapy to the primary tumor site is often recommended; however, the morbidity of radiation may be avoided, and low local recurrence rates maintained (cited Frohm et al. as reference 1).

Added text to state that because of the risk of occult nodal disease, sentinel lymph node (SLN) biopsy is recommended for patients without clinically detectable metastatic disease (cited Cassler et al. as reference 2). Also added that any size of metastatic deposit is currently considered positive with regard to regional lymph node (N) staging; therefore, immunohistochemistry is routinely used to improve detection of micrometastases in SLN (cited Harms and Su et al. as references 3 and 4, respectively).

Stage IV MCC Treatment

Added text to state that avelumab, an anti-programmed death ligand-1 antibody, has been approved by the U.S. Food and Drug Administration as therapy for metastatic MCC, while other immunotherapies for MCC are currently under clinical evaluation. added that the success of immune-based therapies represents a milestone in the management of advanced MCC; however, not all patients respond to immune-based therapies. Furthermore, patients requiring immunosuppression in the setting of solid organ transplants or those with autoimmune disease may not be optimal candidates for immune-based therapy.

This summary is written and maintained by the PDQ Adult Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ® - NCI's Comprehensive Cancer Database pages.

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