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Skin cancer is the abnormal growth of skin cells, often triggered by excessive exposure to ultraviolet (UV) rays from the sun or tanning beds.

It is one of the most common forms of cancer worldwide and can develop on any part of the body, though areas frequently exposed to sunlight are at higher risk. There are several types of skin cancer, each with distinct characteristics and treatment approaches. Among these, Merkel cell carcinoma stands out as a rare but aggressive form requiring prompt attention.

What is Merkel Cell Carcinoma?

Merkel cell carcinoma might sound unfamiliar, but it’s actually a rare type of skin cancer. It often shows up as a hard, rounded bump that’s reddish or purplish and grows pretty fast—sometimes within just a few weeks or months. These nodules don’t usually hurt, but their quick growth is a red flag.

Most of the time, Merkel cell carcinoma nodules pop up on areas of skin that get a lot of sun, like the head, neck, arms, and shoulders. That said, they can also appear in less sun-exposed spots like the trunk or other parts of the body.

Even though it’s not very common, with about 2,500 people in the U.S. diagnosed each year, cases are on the rise. By 2025, experts predict this number will hit around 3,300. The increase is likely tied to our aging population—more people over 65—and possibly because we’re getting better at identifying it.

Now, here’s an interesting twist: for years, people thought Merkel cell carcinoma started in Merkel cells, which are found in the skin’s top layer. But today, most researchers aren’t so sure about that. They’re exploring other possible origins, but for now, the exact type of cell that triggers this cancer remains a bit of a mystery.

What Causes Merkel Cell Carcinoma?

Most cases of Merkel cell carcinoma happen due to UV rays, either from the sun or artificial sources like tanning beds. UV radiation damages the DNA in skin cells, which can lead to cancer.

Interestingly, about 8 out of 10 people with this condition have a virus called the Merkel cell polyomavirus (MCP). But here’s the catch: not everyone with MCP develops cancer. This virus usually shows no symptoms, and there’s no way to screen for it. Experts believe a weakened immune system may allow the virus to trigger cancer by turning off tumor-suppressing genes in the skin cells.

What Increases Your Risk?

Although anyone can develop Merkel cell carcinoma, men over 50 with fair skin face the highest risk. However, several other factors also increase the chances:

History of skin cancer: Basal cell carcinoma, squamous cell carcinoma, or melanoma.

Severe sunburns or tanning bed use: These habits cause long-term skin damage.

Light therapy for skin conditions: Phototherapy for psoriasis or similar diseases can raise your risk.

Weakened immune system: Chronic lymphocytic leukemia, HIV/AIDS, or immunosuppressant use can lower your defenses.

Organ transplant medications: These drugs can also make you more vulnerable.

Recognizing Merkel Cell Carcinoma Symptoms

Knowing the Merkel cell carcinoma signs is crucial for early detection. In individuals with darker skin, tumors may develop on areas like the legs, whereas younger individuals often notice lumps on the torso. Sometimes, these lumps may break open, forming sores or wounds.

Recognizing these changes early can help ensure timely diagnosis and treatment.

Key symptoms of Merkel cell carcinoma include:

  • A shiny lump about the size of a dime that grows rapidly.
  • A firm, dome-shaped, or raised bump.
  • Skin-colored, red, purple, or bluish-red nodules.
  • A tender or itchy area that resembles a pimple or bug bite.

Pay attention to these signs, especially if the lump feels tender, sore, or firm. Early recognition can make all the difference.

How Is Merkel Cell Carcinoma Diagnosed?

Step 1: Physical Exam

The first step in diagnosing Merkel cell carcinoma is a thorough physical exam. Your doctor carefully examines your skin for anything unusual, like moles, freckles, pigmented spots, or other unexpected growths. This initial check helps identify areas that might need further testing.

Step 2: Skin Biopsy

If something suspicious appears, your doctor performs a skin biopsy. This procedure involves removing the tumor or part of it for further examination. A laboratory analysis then checks the sample for cancerous cells, providing a clear diagnosis.

How Doctors Determine the Extent of the Cancer?

Once Merkel cell carcinoma is confirmed, your doctor focuses on determining how far it has spread. This step ensures you receive the right Merkel cell carcinoma treatment plan.

Sentinel Node Biopsy:

To check if cancer has reached your lymph nodes, your doctor may recommend a sentinel node biopsy. This process begins with an injection of dye near the tumor. The dye travels through your lymphatic system and highlights the first lymph nodes it reaches, known as the sentinel nodes. These nodes are then removed and carefully examined under a microscope for cancer cells.

Imaging Tests:

Your doctor might also suggest imaging tests to see if the cancer has spread to other organs. A chest X-ray or CT scan of your chest and abdomen can provide valuable insights.

For more detailed imaging, your doctor may recommend advanced tests like:

PET scan: This uses a radioactive tracer to detect cancer activity throughout the body.

Octreotide scan: In this test, a radioactive tracer highlights cancer cells that might have spread.

By combining these tests, your doctor gathers a complete picture of the cancer’s reach, helping guide the next steps in your care.

How Is Merkel Cell Carcinoma Treated?

Treating this carcinoma often involves a combination of approaches. Here’s a closer look at the main Merkel cell carcinoma treatment options.

Surgery

Surgery is a common first step in treating Merkel cell carcinoma. During the procedure, your doctor removes the tumor along with a margin of healthy skin to ensure all cancer cells are eliminated.

If the cancer has spread to nearby lymph nodes, your doctor performs a lymph node dissection to remove them.

For some patients, Mohs surgery may be an option. In this precise technique, your doctor removes thin layers of tissue one at a time, examining each layer under a microscope for cancer cells. The process repeats until no cancer remains. This method reduces scarring while ensuring all cancerous tissue is removed.

Radiation Therapy

Radiation therapy targets cancer cells with high-energy beams like X-rays or protons. During each session, a specialized machine directs these beams to precise areas of your body.

Doctors often recommend radiation therapy after surgery to destroy any remaining cancer cells. In cases where surgery isn’t an option, radiation therapy can serve as the primary Merkel cell carcinoma treatment. It’s also useful for treating areas where cancer has spread.

Immunotherapy

Immunotherapy enhances your immune system’s ability to recognize and attack cancer cells. Typically reserved for advanced cases where Merkel cell carcinoma has spread beyond the original site, consequently, this treatment boosts the immune response, helping to slow or halt cancer progression.

Chemotherapy

Chemotherapy uses powerful drugs to kill cancer cells. Your doctor may administer these medications through an IV, prescribe them as pills, or combine both methods.

Although chemotherapy isn’t the first choice for Merkel cell carcinoma, it may be recommended if the cancer has spread to lymph nodes or other organs. It’s also an option if the cancer returns after previous Merkel cell carcinoma treatments.

Each Merkel cell carcinoma treatment plan is tailored to your needs, so your doctor will guide you in choosing the best approach for your situation. Furthermore, determining Merkel cell carcinoma stages is critical before moving forward with treatments like surgery, radiation, or immunotherapy.

Conclusion:

In conclusion, Merkel cell carcinoma is a rare but aggressive skin cancer requiring prompt attention. Early detection and personalized treatment plans can improve outcomes. Regular skin checks and awareness of symptoms are essential for timely intervention, ensuring the best possible prognosis and quality of life.