Have you ever noticed a small lump or bump on your skin? You may have thought it was just a pimple or a small wound, but sometimes even small things like this can be more serious than we think. Today we are going to talk about a rare but very dangerous type of skin cancer. That is Merkel Cell Carcinoma, or ``Merkel Cell Carcinoma``.
What is Merkel Cell Carcinoma?
Simply put, Merkel Cell Carcinoma is a rare, rapidly spreading, and potentially life-threatening type of skin cancer. It develops in a special type of cell called Merkel cells, which are found in the outermost layer of our skin, the epidermis.
Think about it, our skin is not just a cover. It has different types of cells. These Merkel cells are also cells that perform such a special function. So, due to exposure to harmful ultraviolet rays from the sun (Ultraviolet - UV light) and some other risk factors, these Merkel cells become cancer cells and start growing uncontrollably. The most dangerous thing about this cancer is that it can spread very quickly to other parts of the body and there is a high chance of it recurring even after treatment.
What are Merkel cells?
Now you might be wondering, "What are Merkel cells?" These cells are found deep in the epidermis, the top layer of our skin. They are a type of cell that is located near nerve endings and helps us feel touch. What's special is that they are a type of cell called a neuroendocrine cell, which is involved in both the nervous system and the endocrine system . That is, these cells also contain substances that act like hormones.
These cells were first discovered and described in the late 1800s by a German physician named Friedrich Merkel. That's why they're called "Merkel cells."
How common is this cancer?
In fact, Merkel Cell Carcinoma is a very rare type of skin cancer. For example, in the United States, only about 3,000 new cases of this disease occur each year.
However, there is something important here. Recently, the number of people developing Merkel Cell Carcinoma has been increasing. Perhaps the reason for this is the improvement in diagnostic tests. Also, this condition mostly affects people over the age of 70. As people live longer, the chances of developing this disease may also increase.
Other names for Merkel Cell Carcinoma
You may hear names like these when talking about this cancer:
- MCC
- Merkel cell cancer
- Neuroendocrine carcinoma of the skin
- Trabecular cancer
What causes Merkel Cell Carcinoma?
Like many skin cancers, Merkel Cell Carcinoma is caused by exposure to ultraviolet (UV) rays from the sun. This risk also exists from artificial light sources such as tanning beds. These UV rays can damage the genetic material, or DNA, of our skin cells.
Another surprising fact is that about eight out of ten people with this cancer are infected with a virus called Merkel cell polyomavirus (MCP). However, don't be alarmed by this. Because, not everyone infected with this `MCP` virus develops this cancer. In fact, this is a virus that is most often infected during childhood and usually does not show any symptoms. There is no special test to find out if this virus is present. So, medical experts are still looking into why this virus causes skin cancer in only some people.
Research suggests that a person with a weakened immune system may not be able to control the virus . The virus then causes skin cells to produce a special protein. This protein turns off genes that normally stop cancer from growing.
What are the risk factors for Merkel Cell Carcinoma?
Merkel Cell Carcinoma can develop in anyone of any age, gender, or skin color. However, the risk is particularly high in men over the age of 50 with fair skin.
In addition, there are several other risk factors:
- If you have previously had other types of skin cancer, such as basal cell carcinoma, squamous cell carcinoma, or melanoma.
- If you have used tanning beds or have severe sunburns.
- If you are taking phototherapy for a skin condition such as psoriasis.
- If the immune system is weakened due to diseases such as chronic lymphocytic leukemia, HIV, and AIDS, or other causes.
- If you are taking organ transplant medications or immunosuppressants after an organ transplant.
What are the symptoms of Merkel Cell Carcinoma?
Merkel cell carcinoma often appears on areas of the skin that are exposed to the sun. You may notice a shiny, pearly-looking lump that has developed in a sun-exposed area.
These bumps are most often seen on your face, neck, arms, or eyelids . In people with darker skin tones, they can sometimes appear on the legs. In younger people, these bumps can appear on areas such as the chest and abdomen (torso). Sometimes, these bumps can burst and look like sores.
This lump may show symptoms such as:
- Ours are about the size of half a coin (about 2 centimeters) and grow very quickly.
- A dome-shaped structure has emerged.
- It feels tight.
- Scratching.
- It may just look like acne or an insect bite.
- It can be the same color as the skin, or red, purple, or blue-red.
- It hurts or feels painful when touched.
Important: If you notice a skin change like this, especially if it gets bigger quickly, be sure to seek medical advice.
What are the complications of Merkel Cell Carcinoma?
Merkel Cell Carcinoma is a very aggressive type of cancer that spreads rapidly to other parts of the body. When cancer spreads from where it first started to other parts of the body, it is called metastatic cancer. Cancers that have spread this way are very difficult to treat.
Merkel cell carcinoma first spreads to the lymphatic system, which is the lymph nodes. From there, it can spread to the bones, lungs, brain, or other organs. This cancer can be fatal.
How is Merkel Cell Carcinoma diagnosed?
Skin conditions like Merkel cell carcinoma are diagnosed and treated by a dermatologist. It is important to see a doctor who specializes in skin cancer. This is because some noncancerous growths (benign cysts), infected hair follicles (folliculitis), and eyelid lumps (styes) can also look like Merkel cell carcinoma.
Your doctor will first examine your entire body. They will also feel for any swollen lymph nodes, which can be a sign of infection or spread of cancer. Then, they will take a small piece of the suspicious lump and do a skin biopsy to check for cancer cells.
What are the stages of cancer?
Doctors use cancer staging to find out how far the cancer has spread. This stage is determined at the time of diagnosis. The higher the stage number, the more the cancer has spread.
- Stage 0: Merkel cell carcinoma is only in the top layer of the skin.
- Stage IV (4): The cancer has spread to distant organs.
What tests are used to determine the stage of cancer?
One or more of these tests may be done to determine the stage of Merkel Cell Carcinoma:
- CT scan
- Positron Emission Tomography (PET) scan
- Sentinel node biopsy or needle biopsy
How is Merkel Cell Carcinoma treated?
Treatment for Merkel cell carcinoma depends on the stage of the cancer. Early-stage (stages 0 to II [2]) cancers respond better to treatment than late-stage (stages III and IV [3 and 4]) cancers.
Doctors surgically remove Merkel cell carcinoma tumors. There are several surgical options:
- Mohs surgery: This involves carefully removing only the layers containing cancer cells, while leaving as much healthy skin as possible.
- Wide local excision: In this, the cancerous tumor is removed along with some of the healthy tissue around it.
- Lymph node dissection: Surgical removal of lymph nodes where cancer cells have spread.
What happens after the surgery?
After surgery, you may need reconstructive surgery or a skin graft to heal and restore the treated area.
In addition, cancer treatments such as these can be used to destroy any cancer cells that may still be left in the body:
- Chemotherapy
- Immunotherapy
- Radiation therapy
Can Merkel Cell Carcinoma be prevented?
Yes, you can protect yourself from sun damage and reduce your risk of developing Merkel Cell Carcinoma by doing the following:
- Apply a broad-spectrum sunscreen with an SPF of at least 60 every day, even when indoors. Reapply every two hours if you're going outside.
- Limit your exposure to the sun's rays, which are at their peak between 10 a.m. and 4 p.m. If you must go outside, find shade.
- Do not use tanning beds or sunlamps.
- When going outside, wear tightly woven clothing, long sleeves, a wide-brimmed hat, and large sunglasses.
- Learn how to examine your skin yourself. If you notice any new changes in your skin, see a doctor immediately.
What is the outlook for someone with Merkel Cell Carcinoma?
Merkel cell carcinoma has a high chance of coming back even after treatment. Therefore, for the first few years, you will need to see your doctor every three to four months and have tests, such as imaging scans, to check for recurrence.
Many factors, including your overall health, age, and the stage of the cancer, affect how long it takes to recover from this cancer. Experts say that three out of four people with localized Merkel cell carcinoma will survive five years after diagnosis. However, if the cancer has spread to other parts of the body (metastatic cancer), that number drops to one in four. But don't give up hope. Many clinical trials are currently underway to find new treatments for Merkel cell carcinoma.
When should you see a doctor?
If you notice any of these unexplained changes in your skin, see a doctor immediately:
- The appearance of a new spot, a change in an existing spot, or bleeding from a spot.
- Scaly or crusty lesions on the skin.
- Non-healing wounds.
- Unexplained lumps, especially if they itch, hurt, or grow in size.
What questions should you ask your doctor?
You can ask your doctor questions like these:
- Why did I get Merkel Cell Carcinoma?
- What is the best treatment for me?
- What can I do to prevent the cancer from coming back?
- Should I be concerned about symptoms of complications?
It's normal to feel shocked and sad when you find out you have skin cancer, such as Merkel Cell Carcinoma. Because this cancer can spread very quickly, it's important to see a doctor as soon as you notice any unusual changes in your skin. Your doctor will remove the tumor with surgery and may also give you other treatments depending on the stage of the cancer. Even after treatment, you should have regular checkups to see if the cancer has come back or spread.
Finally, a few things to remember
So, I hope you now have a better understanding of Merkel Cell Carcinoma, which we talked about today. Although this is a rare, but potentially dangerous cancer, it is very important to take care of your skin and protect it from the sun. If you notice anything new or unusual on your skin, do not ignore it as something minor, but show it to a doctor immediately. If it is detected early, the chances of treatment being successful are higher. Stay healthy!
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