What Is Merkel Cell Carcinoma?

The bump that characterizes MCC tends to grow quickly. Knowing what to look for and catching it early will ensure the best outcome.

• Located on the face, head, neck, or arms
• Firm and dome-shaped or raised
• Pink, red, red-brown, or purple in tone or matching the skin’s color
• Painless
• Fast-growing, usually becoming noticeably bigger in a few weeks to months
• A growing sore that may bleed

• Excessive Exposure to UV Light Chronic, unprotected exposure to UV light from the sun or tanning beds damages the DNA of genes that control skin-cell growth.
• Older Age Though MCC can occur at any age, your risk increases as you get older. The average age of diagnosis is 74.

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• A Weakened Immune System If your immune system is suppressed (as a result of HIV, chronic leukemia, or immunosuppressive drugs), you have a higher risk of developing MCC.
• Light Skin Color MCC is more common in lighter skin complexions than darker skin tones, but it can occur in anybody. More than 9 out of 10 people with MCC have white or lighter skin.
• Sex Males are more likely than females to develop MCC.
• Previous Skin Cancer People with a history of skin cancer have an increased risk of MCC.

• A lymph node biopsy, to see if the cancer has spread to nearby lymph nodes.
• Imaging tests, such as an X-ray, magnetic resonance imaging (MRI), computed tomography (CT) scan, or positron emission tomography (PET) scan of your body to find out if the cancer has spread to other areas.

• Clinical Stage This stage is based on imaging tests, physical exam, and the results of a biopsy. The clinical stage is helpful in planning treatment.
• Pathological Stage This type of staging is based on pathology results after surgery and is done to remove more tissue from around the tumor, as well as from nearby lymph nodes to check for cancer.

• T, which refers to the location and size of the tumor
• N, which refers to the number of lymph nodes involved
• M, for metastasis, means the tumor has spread to distant parts of the body

• Stage 0 The cancer only affects the top layer of skin and has not spread to local tissue or lymph nodes.
• Stage 1 The tumor is no more than 2 centimeters (cm) and has not spread to the lymph nodes or distant parts of the body.
• Stage 2 The cancer is either larger than 2 cm across or has spread to nearby tissues, but it has not affected the lymph nodes or spread to distant areas.
• Stage 3 The tumor may be of any size or may have spread to nearby tissues. The cancer has spread to nearby lymph nodes, but has not yet metastasized to distant areas of the body.
• Stage 4 The tumor may be any size and may have grown into nearby tissue. It may or may not affect the nearby lymph nodes. The cancer has spread to distant parts of the body.

Treatment for MCC depends on the tumor’s size, location, spread, and lymph node involvement.

Localized MCC

MCC With Lymph Node Involvement

Recurring MCC

Metastatic MCC

Metastatic MCC is harder to treat and will require systemic treatment, meaning treatments that affect the whole body. Immunotherapy, which helps the body’s own immune cells recognize and destroy cancer cells, is a popular option for treating MCC that has spread to distant organs.

• avelumab (Bavencio)
• ipilimumab (Yervoy)
• nivolumab (Opdivo)
• pembrolizumab (Keytruda)

To learn more about active MCC clinical trials, eligibility criteria, and location sites, visit the National Institutes of Health website ClinicalTrials.gov.

There are a number of measures you can take to reduce your risk of developing MCC (as well as all skin cancers). It’s never too late to start. Though taking these steps can help reduce your risk, they do not guarantee you will never get MCC.

• Limit UV exposure. You can practice prevention every day by wearing protective hats and clothing, avoiding the midday sun (between 10 a.m. and 3 p.m.) and tanning beds, and using broad-spectrum sunscreen with an SPF of at least 30 or higher, even on cloudy days. Reapply sunscreen every two hours when swimming or sweating.

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• Keep an eye out. MCC lesions don’t have the dramatic look or color of other skin cancers. That’s why it’s so important to closely examine your skin from head to toe once a month, including areas that get a lot of sun exposure like the neck, top of your head, face, legs, and other areas frequently exposed to sunlight. If you notice a new or unusual spot or a raised bump that seems to be growing, contact your doctor right away. Also, check less noticeable areas, including between your toes, on the soles of your feet, buttocks, and genitals.

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• Get screened. See a dermatologist at least once every year for a professional skin exam.

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• Follow up regularly with your dermatologist once treatment is complete. Stick to the exam schedule your doctor recommends. It's the best way to quickly detect a recurrence.
• Play close attention to the site and surrounding region. MCC can return suddenly. Contact your medical team immediately if you see any suspicious changes.
• Consider getting the blood test that can help pick up recurrences early. The Merkel polyomavirus serology test measures antibodies to the Merkel polyomavirus in the blood. It can help pick up recurrences of MCC early, when they can be most effectively treated.

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• Not smoking
• Being physically active
• Eating a nutritious diet
• Maintaining a healthy weight

• Bones
• Lungs
• Brain
• Liver

Support for MCC can take several forms, including patient advocacy groups, counseling or therapy, financial support, and survivor groups.

Neuroendocrine Tumor Research Foundation

This patient-founded organization connects people with different types of support for MCC and other skin cancers. This includes financial assistance, patient advocacy groups, in-person and online support groups, and medication assistance.

American Cancer Society

You can join the Cancer Survivors Network, an online support community, to connect with other survivors and share your journey with people who understand.

You can also ask your dermatologist, oncologist, or other healthcare team members about local support groups in your area or any recommendations for additional help. Many clinics and hospitals have in-house or recommended social workers who can help connect you with support groups, financial aid, advocacy groups, and other helpful resources.

• Merkel cell carcinoma (MCC) is a rare, aggressive form of skin cancer that often does not have very obvious lesions. Rapidly changing and painless areas of skin are the most common symptom.
• MCC is most common in people with lighter skin tones, men, and people older than 70.
• Treatment typically involves the removal of the lesion. More advanced cases may require systemic treatments and the removal of affected lymph nodes.
• Prognosis is generally best for MCC when it’s caught early and when it hasn't spread to other areas of the body, but there is always a chance it will come back. Continual monitoring of the skin as well as limiting UV exposure may prevent recurrence.