What is a Merkel cell carcinoma?
Merkel cell carcinoma (MCC) is a rare form of skin cancer which starts in the Merkel cells, which are usually in the top layer of the skin (the epidermis).
What does Merkel cell carcinoma look like?
The first symptoms of Merkel cell carcinoma often present in the form of a rapidly growing lump on the skin. The lump is often bluish red in colour and about 1 to 5 cm across, although sometimes they may be larger. The skin over them is usually firm (not broken) and they don’t hurt.
Merkel cell carcinoma is most often found in the areas of the body that get the most direct sun – the head, neck, arms and legs.
What causes Merkel cell carcinoma?
It is thought that immunosuppression is an important factor for the development of Merkel cell carcinoma. Although the cause is not fully understood, there is strong evidence to suggest that Ultraviolet (UV) rays from the sun, or using sun beds, can do damage to the skin.
Other factors that can increase your risk include:
- Ultraviolet light (UVA) and psoralen ultraviolet light treatment (PUVA) for certain skin conditions such as psoriasis.
- Conditions or treatments that can weaken your immune system, including people who have had an organ transplant and people who have AIDS.
What types of treatment are used?
The main way to both diagnose and treat Merkel cell carcinoma is to remove the lesion with surgery, which we call an excision biopsy followed by a laboratory diagnosis to confirm lesion type.
Excision biopsy
This involves removing the lesion, usually under a local anaesthetic. The lesion is sent to be examined under the microscope. It may take two or three weeks for the results of the biopsy to be sent back to the consultant.
Wide local excision
If a Merkel cell carcinoma is diagnosed as a result of the excision biopsy, the consultant or doctor may recommend a wide local excision (WLE). This involves another operation to remove an extra margin of skin from around the original Merkel cell carcinoma site, which is again examined under a microscope. This operation is to reduce the risk of any Merkel cells being left behind in the surrounding skin.
If possible, the wound will be stitched closed, although sometimes it is necessary to repair the area with a skin graft or other types of plastic surgery. You may require time to get back to your usual routine depending on the type of surgery you have had.
Further treatment
There is a small chance that your Merkel cell carcinoma may spread or reoccur, if this should happen it is usually removed by further surgery.
We will discuss your care at our multi-disciplinary team meeting and Oncology treatment may be recommended.
If this is the case, you will be referred to an Oncology centre and considered for radiotherapy, Immunotherapy or
Chemotherapy.
If any Merkel cell carcinoma cells have broken away from the tumour before it was removed, there is a chance that they may spread to your lymph nodes. Lymph nodes are present throughout the body; their purpose is to fight off infections. If the cancer cells spread from the Merkel cell carcinoma, they can lodge in the nodes. This may produce lumps, either painful or painless, in the neck, armpits or groins, depending on the site of the initial Merkel cell carcinoma.
Even more rarely, in a very small number of people, the Merkel cell carcinoma can spread beyond the local lymph nodes to distant nodes, distant skin or other organs, such as the lung, brain or liver.
Any unusual symptoms that persist should be reported. If you would like more information on this, please discuss it with your Skin Cancer Clinical Nurse Specialist. If discharged, please go directly to your GP.
Follow-up
Once your treatment is complete, you will have a check-up at the hospital to review the scar and surgical site. A follow-up plan will also be discussed. The follow-up plan check-up schedule is usually as follows:
- Years 0-3 - every three months
- Years 3-5 - every six months
- Years 5-10 - yearly and you may also need to have regular 6 monthly CT scans before you are discharged
If you started your treatment at another hospital, we would discuss referring you back to them for your follow up.
Self-examination
You will be shown how to examine yourself to detect any recurrence at the site of removal or in the surrounding skin. This is probably one of the most important things you can do to help yourself. The chance of the Merkel cell carcinoma returning remains small for the majority of people.
Although initially you will be examined at a check-up, it is important that once a month you perform your own examination at home.
Take time to look at and feel the scar and the surrounding area. One of the easiest ways to do this is to feel the scar with your hand flat against the skin. Many people find this works well whilst having a bath or a shower. This same technique can be used to check the skin between the scar and the lymph nodes and the nodes themselves.
- For Merkel cell carcinoma in the head or neck area, you need to examine nodes that are on the side of the neck, under the chin, above the collarbones, behind the ears and at the back of the neck.
- For Merkel cell carcinoma on the arm, the spread may occur in the armpit on the affected side, above the collarbones and in the lower neck.
- For Merkel cell carcinoma on the leg, the nodes behind the knees and in the groin need to be checked. A useful tip is to compare one side of your body with the other.
- For Merkel cell carcinoma on the front or back of your body, please check your groins, armpits and lower neck.
What to look for
Check for any new or existing lumps or lesions that change colour, bleed or itch. Most changes are harmless, but they may indicate the start of a skin cancer.
If you are in doubt, contact your Skin Cancer Clinical Nurse Specialist, or if you have been discharged from our service, please contact your GP.
What to do if you are worried?
If you have been discharged, please see your GP.
If you are under regular follow-up, please feel free to telephone your Skin Cancer Clinical Nurse Specialist. We
would much rather talk it over with you on the telephone or see you and hopefully reassure you rather than have you worry and risk delaying treatment. Our telephone numbers are at the bottom of this page.
Future protection
- Check your skin monthly for any existing or new skin lumps or moles that enlarge, change colour, bleed, or itch.
- Most changes are harmless, but they may indicate the start of a skin cancer. See your doctor if in doubt.
- Take care whilst in the sun by wearing protective clothing and using high factor sunscreens (SPF 30+).
- Wearing a hat with a large brim is recommended.
- Avoid strong sunshine between 11am and 3pm.
- Avoid using sunbeds.
- Pass on the message to friends and family about protecting themselves and checking their moles and skin.
Insurance
If you already have life insurance, you may need to inform them of your diagnosis.
If you have critical illness insurance, you may be able to make a claim.
Travel insurance
Getting travel insurance when you have had cancer can be difficult. From the company’s point of view, you are a higher risk. As they see it, having been ill, you are more likely to need medical treatment while you are abroad, or they may think that illness could cause you to cancel your trip at the last minute.
However, finding travel insurance is getting easier. Fortunately, many insurance companies are now looking at
cases individually rather than refusing everyone with a history of cancer.