Neuroendocrine tumours
Find out about Merkel cell carcinoma. This is a rare type of neuroendocrine tumour.
Merkel cell cancers are a rare type of skin cancer. They develop in Merkel cells which are in the top layer of the skin. These cells are near the nerve endings and they help us respond to touch. Merkel cell cancers are a rare type of neuroendocrine tumour.
As with other types of skin cancer long term exposure to sunlight increases your risk of getting Merkel cell cancer. Other factors that can increase your risk include:
Merkel cell cancer usually appears as a lump on the skin. The lumps are usually bluish red in colour and about 1 to 5 cm across, although they are sometimes larger. The skin over them is not usually broken (ulcerated). They are most often found in the areas of the body that get the most direct sun such as the:
Unfortunately, unlike most other types of skin cancer, Merkel cell cancer can grow very quickly. It can often spread to other parts of the body such as the lymph nodes, lungs, liver or bone.
Most people who are diagnosed with Merkel cell carcinoma will need to have further tests to see if the cancer has spread. You might have a:
When somebody is diagnosed with any type of cancer, the cancer is staged. This means finding out exactly how big or deep the cancer is. Also if it has spread to any of the nearby lymph nodes or to other parts of the body.
Staging is a very important process as it helps doctors to decide on the best treatment.
The main treatment is surgery to remove it if the cancer is only in the surface layers of skin (localised). This is a rare cancer so treatment should be carried out at a specialist skin cancer centre. The team of doctors should include a:
They will aim to remove all of the cancer cells and you might hear them use the term clear margins. This means that all the signs of the cancer have been removed. To make sure of this, the surgeon will send the tissue that he or she has removed to the laboratory. A specialist will examine it very closely to make sure there is a clear margin of healthy tissue around all the cancerous tissue that has been removed.
Your doctor will also be able to explain whether or not you need to have any lymph nodes removed and whether you will need any further treatment or scans afterwards.
It is quite common for specialists to recommend radiotherapy after surgery. The aim of the radiotherapy is to kill off any cancer cells that may have been left behind, but are too small to be seen. Sometimes, if surgery is very difficult or the lump is very large, radiotherapy might be used on its own. This usually works very well.
Merkel cell carcinoma can spread into the skin as lumps. This can be in the area it started or into the local lymph nodes. Any spread of the cancer can be treated by surgery, with or without radiotherapy.
Isolated limb perfusion (ILP) might also work very well. In ILP the blood supply of the affected limb is isolated (blocked off). Then oxygen and chemotherapy are put into the limb. After the oxygen and chemotherapy have circulated, the blood supply is returned to normal. Isolated limb infusion (ILI) is a newer version of ILP. No oxygen is used. This means ILI takes less time to do. Some studies have found that patients have less problems after ILI.
Chemotherapy can usually control Merkel cell cancers that have spread to other parts of the body. The drugs you might have are carboplatin or cisplatin with etoposide. The chemotherapy treatment might control the cancer for a while, but unfortunately it is not a cure.
Coping with a diagnosis of a more aggressive cancer can be especially difficult, both practically and emotionally. Being well informed about your cancer and its treatment can make it easier to make decisions and cope with what happens.
Talking to other people who have the same thing can also help.
Our discussion forum Cancer Chat is a place for anyone affected by cancer. You can share experiences, stories and information with other people who know what you are going through.
The Rare Cancer Alliance offer support and information to people affected by rare cancers.
A review of radiotherapy for merkel cell carcinoma of the head and neck
J Lee and others
Journal of Skin Cancer, 2012
Cancer: Principles and Practice of Oncology (9th edition)
VT DeVita, TS Lawrence, SA Rosenberg
Lipincott, Williams and Wilkins, 2011
Merkel cell carcinoma
JC Becker
Annals of Oncology, 2010
Volume 21, Supplement 7
Merkel cell carcinoma: interdisciplinary management of a rare disease
S Schneider, D Thurnher, BM Erovic
Journal of Skin Cancer, 2013
Volume 2013
Merkel cell carcinoma: recent progress and current priorities on etiology, pathogenesis, and clinical management
Rockville Merkel Cell Carcinoma Group
Journal of Clinical Oncology, 2009
Volume 27, Issue 24
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Neuroendocrine tumours
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