A case of Merkel cell carcinoma
Main Article Content
Abstract
Merckel cell cancer is a rare Neuroendocrine malignant neoplasm of the skin. Major risk factors are advanced age, UV radiation and Immunocompromised state. Treatment of primary Merkel cell cancer involves surgical resection and adjuvant radiotherapy. Chemotherapy and Immunotherapy are usually reserved for treating advanced metastatic cases. We present a case of sixty-seven-year-old man who is diagnosed with metastatic Merckel cell cancer of skin and lymph nodes. After consultation with multidisciplinary team, the patient started immunotherapy with Avelumab. He later received concurrent Radiation therapy with short lasting response. Unfortunately, his disease progressed, and the patient received one cycle of chemotherapy prior to transitioning to comfort care.
Keywords:
Merkel Cell Carcinoma (MCC), Metastatic MCC, Immunotherapy, Immune Checkpoint Inhibitors, Lymphadenopathy, A case of Merkel cell carcinoma
Article Details
How to Cite
KALLURI, Sowjanya et al.
A case of Merkel cell carcinoma.
Medical Research Archives, [S.l.], v. 12, n. 7, july 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5486>. Date accessed: 15 nov. 2024.
doi: https://doi.org/10.18103/mra.v12i7.5486.
Section
Case Reports
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Patel P, Hussain K. Merkel cell carcinoma. Clin Exp Dermatol. 2021 Jul;46(5):814-819. doi: 10.111 1/ced.14530. Epub 2021 Jan 5. PMID: 33252781.
2. Agelli M, Clegg LX. Epidemiology of primary Merkel cell carcinoma in the United States. J Am Acad Dermatol. 2003 Nov;49(5):832-41. doi: 10.10 16/s0190-9622(03)02108-x. Erratum in: J Am Acad Dermatol. 2004 May;50(5):733. PMID: 14576661.
3. Gauci ML, Aristei C, Becker JC, Blom A, Bataille V, Dreno B, Del Marmol V, Forsea AM, Fargnoli MC, Grob JJ, Gomes F, Hauschild A, Hoeller C, Harwood C, Kelleners-Smeets N, Kaufmann R, Lallas A, Malvehy J, Moreno-Ramirez D, Peris K, Pellacani G, Saiag P, Stratigos AJ, Vieira R, Zalaudek I, van Akkooi ACJ, Lorigan P, Garbe C, Lebbé C; European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO) and the European Organization for Research and Treatment of Cancer (EORTC). Diagnosis and treatment of Merkel cell carcinoma: European consensus-based interdisciplinary guideline - Update 2022. Eur J Cancer. 2022 Aug;171:203-231. doi: 10.1016/j.ejca.2022.03.043 . Epub 2022 Jun 19. PMID: 35732101.
4. Becker JC, Stang A, DeCaprio JA, Cerroni L, Lebbé C, Veness M, Nghiem P. Merkel cell carcinoma. Nat Rev Dis Primers. 2017 Oct 26;3:17077. doi: 10.1038/nrdp.2017.77. PMID: 29072302; PMCID: PMC6054450.
5. McAfee WJ, Morris CG, Mendenhall CM, Werning JW, Mendenhall NP, Mendenhall WM. Merkel cell carcinoma: treatment and outcomes. Cancer. 2005 Oct 15;104(8):1761-4. doi: 10.1002 /cncr.21355. PMID: 16136596.
6. Lewis DJ, Sobanko JF, Etzkorn JR, Shin TM, Giordano CN, McMurray SL, Walker JL, Zhang J, Miller CJ, Higgins HW 2nd. Merkel Cell Carcinoma. Dermatol Clin. 2023 Jan;41(1):101-115. doi: 10.1016/j.det.2022.07.015. Epub 2022 Oct 28. PMID: 36410971.
7. Tanda ET, d'Amato AL, Rossi G, Croce E, Boutros A, Cecchi F, Spagnolo F, Queirolo P. Merkel Cell Carcinoma: An Immunotherapy Fairy-Tale? Front Oncol. 2021 Sep 23;11:739006. doi: 10.3389/fonc.2021.739006. PMID: 34631574; PMCID: PMC8495203.
8. Paulson KG, Park SY, Vandeven NA, Lachance K, Thomas H, Chapuis AG, Harms KL, Thompson JA, Bhatia S, Stang A, Nghiem P. Merkel cell carcinoma: Current US incidence and projected increases based on changing demographics. J Am Acad Dermatol. 2018 Mar;78(3):457-463.e2. doi: 10.1016/j.jaad.2017.10.028. Epub 2017 Nov 2. PMID: 29102486; PMCID: PMC5815902.
9. Leech SN, Kolar AJ, Barrett PD, Sinclair SA, Leonard N. Merkel cell carcinoma can be distinguished from metastatic small cell carcinoma using antibodies to cytokeratin 20 and thyroid transcription factor 1. J Clin Pathol. 2001 Sep;54(9):727-9. doi: 10.1136/jcp.54.9.727. PMID: 11533085; PMCID: PMC1731517.
10. Heath M, Jaimes N, Lemos B, Mostaghimi A, Wang LC, Peñas PF, Nghiem P. Clinical characteristics of Merkel cell carcinoma at diagnosis in 195 patients: the AEIOU features. J Am Acad Dermatol. 2008 Mar;58(3):375-81. doi: 10.1016/j.jaad.2007.11.020. PMID: 18280333; PMCID: PMC2335370.
11. Fields RC, Busam KJ, Chou JF, Panageas KS, Pulitzer MP, Allen PJ, Kraus DH, Brady MS, Coit DG. Five hundred patients with Merkel cell carcinoma evaluated at a single institution. Ann Surg. 2011 Sep;254(3):465-73; discussion 473-5. doi: 10.1097/SLA.0b013e31822c5fc1. Erratum in: Ann Surg. 2012 Feb;255(2):404. PMID: 21865945.
12. Heath M, Jaimes N, Lemos B, Mostaghimi A, Wang LC, Peñas PF, Nghiem P. Clinical characteristics of Merkel cell carcinoma at diagnosis in 195 patients: the AEIOU features. J Am Acad Dermatol. 2008 Mar;58(3):375-81. doi: 10.1016/j.jaad.2007.11.020. PMID: 18280333; PMCID: PMC2335370.
13. Agelli M, Clegg LX. Epidemiology of primary Merkel cell carcinoma in the United States. J Am Acad Dermatol. 2003 Nov;49(5):832-41. doi: 10.10 16/s0190-9622(03)02108-x. Erratum in: J Am Acad Dermatol. 2004 May;50(5):733. PMID: 14576661.
14. Engels EA, Frisch M, Goedert JJ, Biggar RJ, Miller RW. Merkel cell carcinoma and HIV infection. Lancet. 2002 Feb 9;359(9305):497-8. doi: 10.1016/ S0140-6736(02)07668-7. PMID: 11853800.
15. Koljonen V, Kukko H, Tukiainen E, Böhling T, Sankila R, Pukkala E, Sihto H, Joensuu H, Kyllönen L, Mäkisalo H. Incidence of Merkel cell carcinoma in renal transplant recipients. Nephrol Dial Transplant. 2009 Oct;24(10):3231-5. doi: 10.1093/ ndt/gfp334. Epub 2009 Jul 8. PMID: 19586970.
16. Koljonen V, Kukko H, Pukkala E, Sankila R, Böhling T, Tukiainen E, Sihto H, Joensuu H. Chronic lymphocytic leukaemia patients have a high risk of Merkel-cell polyomavirus DNA-positive Merkel-cell carcinoma. Br J Cancer. 2009 Oct 20;101(8):1444-7. doi: 10.1038/sj.bjc.6605306. Epub 2009 Sep 15. PMID: 19755994; PMCID: PMC2768432.
17. Santos-Juanes J, Fernández-Vega I, Fuentes N, Galache C, Coto-Segura P, Vivanco B, Astudillo A, Martínez-Camblor P. Merkel cell carcinoma and Merkel cell polyomavirus: a systematic review and meta-analysis. Br J Dermatol. 2015 Jul;173(1):42-9. doi: 10.1111/bjd.13870. Epub 2015 Jun 12. PMID: 25919492.
18. Hall BJ, Pincus LB, Yu SS, Oh DH, Wilson AR, McCalmont TH. Immunohistochemical prognostication of Merkel cell carcinoma: p63 expression but not polyomavirus status correlates with outcome. J Cutan Pathol. 2012 Oct;39(10):911-7. doi: 10.1111/j.1600-0560.2012.01964.x. Epub 2012 Aug 6. PMID: 22882157.
19. Johansson L, Tennvall J, Akerman M. Immunohistochemical examination of 25 cases of Merkel cell carcinoma: a comparison with small cell carcinoma of the lung and oesophagus, and a review of the literature. APMIS. 1990 Aug;98(8): 741-52. doi: 10.1111/j.1699-0463.1990.tb04995.x. PMID: 1698390.
20. Hanly AJ, Elgart GW, Jorda M, Smith J, Nadji M. Analysis of thyroid transcription factor-1 and cytokeratin 20 separates merkel cell carcinoma from small cell carcinoma of lung. J Cutan Pathol. 2000 Mar;27(3):118-20. doi: 10.1034/j.1600-0560.2000.027003118.x. PMID: 10728812.
21. Sidiropoulos M, Hanna W, Raphael SJ, Ghorab Z. Expression of TdT in Merkel cell carcinoma and small cell lung carcinoma. Am J Clin Pathol. 2011 Jun;135(6):831-8. doi: 10.1309/AJCPLCB2Q9QXD ZAA. PMID: 21571955.
22. Panse G, McNiff JM, Ko CJ. Basal cell carcinoma: CD56 and cytokeratin 5/6 staining patterns in the differential diagnosis with Merkel cell carcinoma. J Cutan Pathol. 2017 Jun;44(6):553-556. doi: 10.1111/cup.12950. PMID: 28403527.
23. Singh N, Alexander NA, Lachance K, Lewis CW, McEvoy A, Akaike G, Byrd D, Behnia S, Bhatia S, Paulson KG, Nghiem P. Clinical benefit of baseline imaging in Merkel cell carcinoma: Analysis of 584 patients. J Am Acad Dermatol. 2021 Feb;84(2):330-339. doi: 10.1016/j.jaad.2020.07.06 5. Epub 2020 Jul 21. PMID: 32707254; PMCID: PMC7854967.
24. Eftekhari F, Wallace S, Silva EG, Lenzi R. Merkel cell carcinoma of the skin: imaging and clinical features in 93 cases. Br J Radiol. 1996 Mar;69(819):226-33. doi: 10.1259/0007-1285-69-819-226. PMID: 8800866.
25. Andea AA, Coit DG, Amin B, Busam KJ. Merkel cell carcinoma: histologic features and prognosis. Cancer. 2008 Nov 1;113(9):2549-58. doi: 10.1002/cncr.23874. PMID: 18798233.
26. Wright GP, Holtzman MP. Surgical resection improves median overall survival with marginal improvement in long-term survival when compared with definitive radiotherapy in Merkel cell carcinoma: A propensity score matched analysis of the National Cancer Database. Am J Surg. 2018 Mar;215(3):384-387. doi: 10.1016/j.amjsurg.201 7.10.045. Epub 2017 Nov 11. PMID: 29157891.
27. Chen MM, Roman SA, Sosa JA, Judson BL. The role of adjuvant therapy in the management of head and neck merkel cell carcinoma: an analysis of 4815 patients. JAMA Otolaryngol Head Neck Surg. 2015 Feb;141(2):137-41. doi: 10.1001/jamao to.2014.3052. PMID: 25474617.
28. Singh B, Qureshi MM, Truong MT, Sahni D. Demographics and outcomes of stage I and II Merkel cell carcinoma treated with Mohs micrographic surgery compared with wide local excision in the National Cancer Database. J Am Acad Dermatol. 2018 Jul;79(1):126-134.e3. doi: 10.1016/j.jaad.2018.01.041. Epub 2018 Feb 3. PMID: 29408552.
29. Koh CS, Veness MJ. Role of definitive radiotherapy in treating patients with inoperable Merkel cell carcinoma: the Westmead Hospital experience and a review of the literature. Australas J Dermatol. 2009 Nov;50(4):249-56. doi: 10.1111/ j.1440-0960.2009.00532.x. PMID: 19916967.
30. Fenig E, Brenner B, Katz A, Rakovsky E, Hana MB, Sulkes A. The role of radiation therapy and chemotherapy in the treatment of Merkel cell carcinoma. Cancer. 1997 Sep 1;80(5):881-5. doi: 10.1002/(sici)1097-0142(19970901)80:5<881::aid-cncr8>3.0.co;2-o. PMID: 9307187.
31. Harrington C, Kwan W. Outcomes of Merkel cell carcinoma treated with radiotherapy without radical surgical excision. Ann Surg Oncol. 2014 Oct;21(11):3401-5. doi: 10.1245/s10434-014-3757-8. Epub 2014 Jul 8. PMID: 25001091.
32. Sims JR, Grotz TE, Pockaj BA, Joseph RW, Foote RL, Otley CC, Weaver AL, Jakub JW, Price DL. Sentinel lymph node biopsy in Merkel cell carcinoma: The Mayo Clinic experience of 150 patients. Surg Oncol. 2018 Mar;27(1):11-17. doi: 10.1016/j.suronc.2017.10.005. Epub 2017 Oct 26. PMID: 29549898.
33. Poulsen MG, Rischin D, Porter I, Walpole E, Harvey J, Hamilton C, Keller J, Tripcony L. Does chemotherapy improve survival in high-risk stage I and II Merkel cell carcinoma of the skin? Int J Radiat Oncol Biol Phys. 2006 Jan 1;64(1):114-9. doi: 10.1016/j.ijrobp.2005.04.042. Epub 2005 Aug 25. PMID: 16125873.
34. D'Angelo SP, Lebbé C, Mortier L, Brohl AS, Fazio N, Grob JJ, Prinzi N, Hanna GJ, Hassel JC, Kiecker F, Georges S, Ellers-Lenz B, Shah P, Güzel G, Nghiem P. First-line avelumab in a cohort of 116 patients with metastatic Merkel cell carcinoma (JAVELIN Merkel 200): primary and biomarker analyses of a phase II study. J Immunother Cancer. 2021 Jul;9(7):e002646. doi: 10.1136/jitc-2021-002646. PMID: 34301810; PMCID: PMC8311489.
35. Nghiem PT, Bhatia S, Lipson EJ, Kudchadkar RR, Miller NJ, Annamalai L, Berry S, Chartash EK, Daud A, Fling SP, Friedlander PA, Kluger HM, Kohrt HE, Lundgren L, Margolin K, Mitchell A, Olencki T, Pardoll DM, Reddy SA, Shantha EM, Sharfman WH, Sharon E, Shemanski LR, Shinohara MM, Sunshine JC, Taube JM, Thompson JA, Townson SM, Yearley JH, Topalian SL, Cheever MA. PD-1 Blockade with Pembrolizumab in Advanced Merkel-Cell Carcinoma. N Engl J Med. 2016 Jun 30;374(26):2542-52. doi: 10.1056/NEJM oa1603702. Epub 2016 Apr 19. PMID: 27093365; PMCID: PMC4927341.
36. Tai PT, Yu E, Winquist E, Hammond A, Stitt L, Tonita J, Gilchrist J. Chemotherapy in neuroendocrine/Merkel cell carcinoma of the skin: case series and review of 204 cases. J Clin Oncol. 2000 Jun;18(12):2493-9. doi: 10.1200/JCO.2000.1 8.12.2493. PMID: 10856110.
37. Iyer JG, Blom A, Doumani R, Lewis C, Tarabadkar ES, Anderson A, Ma C, Bestick A, Parvathaneni U, Bhatia S, Nghiem P. Response rates and durability of chemotherapy among 62 patients with metastatic Merkel cell carcinoma. Cancer Med. 2016 Sep;5(9):2294-301. doi: 10.1002/cam4.815. Epub 2016 Jul 19. PMID: 27431483; PMCID: PMC5055152.
38. Nghiem P, Kaufman HL, Bharmal M, Mahnke L, Phatak H, Becker JC. Systematic literature review of efficacy, safety and tolerability outcomes of chemotherapy regimens in patients with metastatic Merkel cell carcinoma. Future Oncol. 2017 Jun;13(14):1263-1279. doi: 10.2217/fon-2017-0072. Epub 2017 Mar 28. PMID: 28350180; PMCID: PMC6040046.
2. Agelli M, Clegg LX. Epidemiology of primary Merkel cell carcinoma in the United States. J Am Acad Dermatol. 2003 Nov;49(5):832-41. doi: 10.10 16/s0190-9622(03)02108-x. Erratum in: J Am Acad Dermatol. 2004 May;50(5):733. PMID: 14576661.
3. Gauci ML, Aristei C, Becker JC, Blom A, Bataille V, Dreno B, Del Marmol V, Forsea AM, Fargnoli MC, Grob JJ, Gomes F, Hauschild A, Hoeller C, Harwood C, Kelleners-Smeets N, Kaufmann R, Lallas A, Malvehy J, Moreno-Ramirez D, Peris K, Pellacani G, Saiag P, Stratigos AJ, Vieira R, Zalaudek I, van Akkooi ACJ, Lorigan P, Garbe C, Lebbé C; European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO) and the European Organization for Research and Treatment of Cancer (EORTC). Diagnosis and treatment of Merkel cell carcinoma: European consensus-based interdisciplinary guideline - Update 2022. Eur J Cancer. 2022 Aug;171:203-231. doi: 10.1016/j.ejca.2022.03.043 . Epub 2022 Jun 19. PMID: 35732101.
4. Becker JC, Stang A, DeCaprio JA, Cerroni L, Lebbé C, Veness M, Nghiem P. Merkel cell carcinoma. Nat Rev Dis Primers. 2017 Oct 26;3:17077. doi: 10.1038/nrdp.2017.77. PMID: 29072302; PMCID: PMC6054450.
5. McAfee WJ, Morris CG, Mendenhall CM, Werning JW, Mendenhall NP, Mendenhall WM. Merkel cell carcinoma: treatment and outcomes. Cancer. 2005 Oct 15;104(8):1761-4. doi: 10.1002 /cncr.21355. PMID: 16136596.
6. Lewis DJ, Sobanko JF, Etzkorn JR, Shin TM, Giordano CN, McMurray SL, Walker JL, Zhang J, Miller CJ, Higgins HW 2nd. Merkel Cell Carcinoma. Dermatol Clin. 2023 Jan;41(1):101-115. doi: 10.1016/j.det.2022.07.015. Epub 2022 Oct 28. PMID: 36410971.
7. Tanda ET, d'Amato AL, Rossi G, Croce E, Boutros A, Cecchi F, Spagnolo F, Queirolo P. Merkel Cell Carcinoma: An Immunotherapy Fairy-Tale? Front Oncol. 2021 Sep 23;11:739006. doi: 10.3389/fonc.2021.739006. PMID: 34631574; PMCID: PMC8495203.
8. Paulson KG, Park SY, Vandeven NA, Lachance K, Thomas H, Chapuis AG, Harms KL, Thompson JA, Bhatia S, Stang A, Nghiem P. Merkel cell carcinoma: Current US incidence and projected increases based on changing demographics. J Am Acad Dermatol. 2018 Mar;78(3):457-463.e2. doi: 10.1016/j.jaad.2017.10.028. Epub 2017 Nov 2. PMID: 29102486; PMCID: PMC5815902.
9. Leech SN, Kolar AJ, Barrett PD, Sinclair SA, Leonard N. Merkel cell carcinoma can be distinguished from metastatic small cell carcinoma using antibodies to cytokeratin 20 and thyroid transcription factor 1. J Clin Pathol. 2001 Sep;54(9):727-9. doi: 10.1136/jcp.54.9.727. PMID: 11533085; PMCID: PMC1731517.
10. Heath M, Jaimes N, Lemos B, Mostaghimi A, Wang LC, Peñas PF, Nghiem P. Clinical characteristics of Merkel cell carcinoma at diagnosis in 195 patients: the AEIOU features. J Am Acad Dermatol. 2008 Mar;58(3):375-81. doi: 10.1016/j.jaad.2007.11.020. PMID: 18280333; PMCID: PMC2335370.
11. Fields RC, Busam KJ, Chou JF, Panageas KS, Pulitzer MP, Allen PJ, Kraus DH, Brady MS, Coit DG. Five hundred patients with Merkel cell carcinoma evaluated at a single institution. Ann Surg. 2011 Sep;254(3):465-73; discussion 473-5. doi: 10.1097/SLA.0b013e31822c5fc1. Erratum in: Ann Surg. 2012 Feb;255(2):404. PMID: 21865945.
12. Heath M, Jaimes N, Lemos B, Mostaghimi A, Wang LC, Peñas PF, Nghiem P. Clinical characteristics of Merkel cell carcinoma at diagnosis in 195 patients: the AEIOU features. J Am Acad Dermatol. 2008 Mar;58(3):375-81. doi: 10.1016/j.jaad.2007.11.020. PMID: 18280333; PMCID: PMC2335370.
13. Agelli M, Clegg LX. Epidemiology of primary Merkel cell carcinoma in the United States. J Am Acad Dermatol. 2003 Nov;49(5):832-41. doi: 10.10 16/s0190-9622(03)02108-x. Erratum in: J Am Acad Dermatol. 2004 May;50(5):733. PMID: 14576661.
14. Engels EA, Frisch M, Goedert JJ, Biggar RJ, Miller RW. Merkel cell carcinoma and HIV infection. Lancet. 2002 Feb 9;359(9305):497-8. doi: 10.1016/ S0140-6736(02)07668-7. PMID: 11853800.
15. Koljonen V, Kukko H, Tukiainen E, Böhling T, Sankila R, Pukkala E, Sihto H, Joensuu H, Kyllönen L, Mäkisalo H. Incidence of Merkel cell carcinoma in renal transplant recipients. Nephrol Dial Transplant. 2009 Oct;24(10):3231-5. doi: 10.1093/ ndt/gfp334. Epub 2009 Jul 8. PMID: 19586970.
16. Koljonen V, Kukko H, Pukkala E, Sankila R, Böhling T, Tukiainen E, Sihto H, Joensuu H. Chronic lymphocytic leukaemia patients have a high risk of Merkel-cell polyomavirus DNA-positive Merkel-cell carcinoma. Br J Cancer. 2009 Oct 20;101(8):1444-7. doi: 10.1038/sj.bjc.6605306. Epub 2009 Sep 15. PMID: 19755994; PMCID: PMC2768432.
17. Santos-Juanes J, Fernández-Vega I, Fuentes N, Galache C, Coto-Segura P, Vivanco B, Astudillo A, Martínez-Camblor P. Merkel cell carcinoma and Merkel cell polyomavirus: a systematic review and meta-analysis. Br J Dermatol. 2015 Jul;173(1):42-9. doi: 10.1111/bjd.13870. Epub 2015 Jun 12. PMID: 25919492.
18. Hall BJ, Pincus LB, Yu SS, Oh DH, Wilson AR, McCalmont TH. Immunohistochemical prognostication of Merkel cell carcinoma: p63 expression but not polyomavirus status correlates with outcome. J Cutan Pathol. 2012 Oct;39(10):911-7. doi: 10.1111/j.1600-0560.2012.01964.x. Epub 2012 Aug 6. PMID: 22882157.
19. Johansson L, Tennvall J, Akerman M. Immunohistochemical examination of 25 cases of Merkel cell carcinoma: a comparison with small cell carcinoma of the lung and oesophagus, and a review of the literature. APMIS. 1990 Aug;98(8): 741-52. doi: 10.1111/j.1699-0463.1990.tb04995.x. PMID: 1698390.
20. Hanly AJ, Elgart GW, Jorda M, Smith J, Nadji M. Analysis of thyroid transcription factor-1 and cytokeratin 20 separates merkel cell carcinoma from small cell carcinoma of lung. J Cutan Pathol. 2000 Mar;27(3):118-20. doi: 10.1034/j.1600-0560.2000.027003118.x. PMID: 10728812.
21. Sidiropoulos M, Hanna W, Raphael SJ, Ghorab Z. Expression of TdT in Merkel cell carcinoma and small cell lung carcinoma. Am J Clin Pathol. 2011 Jun;135(6):831-8. doi: 10.1309/AJCPLCB2Q9QXD ZAA. PMID: 21571955.
22. Panse G, McNiff JM, Ko CJ. Basal cell carcinoma: CD56 and cytokeratin 5/6 staining patterns in the differential diagnosis with Merkel cell carcinoma. J Cutan Pathol. 2017 Jun;44(6):553-556. doi: 10.1111/cup.12950. PMID: 28403527.
23. Singh N, Alexander NA, Lachance K, Lewis CW, McEvoy A, Akaike G, Byrd D, Behnia S, Bhatia S, Paulson KG, Nghiem P. Clinical benefit of baseline imaging in Merkel cell carcinoma: Analysis of 584 patients. J Am Acad Dermatol. 2021 Feb;84(2):330-339. doi: 10.1016/j.jaad.2020.07.06 5. Epub 2020 Jul 21. PMID: 32707254; PMCID: PMC7854967.
24. Eftekhari F, Wallace S, Silva EG, Lenzi R. Merkel cell carcinoma of the skin: imaging and clinical features in 93 cases. Br J Radiol. 1996 Mar;69(819):226-33. doi: 10.1259/0007-1285-69-819-226. PMID: 8800866.
25. Andea AA, Coit DG, Amin B, Busam KJ. Merkel cell carcinoma: histologic features and prognosis. Cancer. 2008 Nov 1;113(9):2549-58. doi: 10.1002/cncr.23874. PMID: 18798233.
26. Wright GP, Holtzman MP. Surgical resection improves median overall survival with marginal improvement in long-term survival when compared with definitive radiotherapy in Merkel cell carcinoma: A propensity score matched analysis of the National Cancer Database. Am J Surg. 2018 Mar;215(3):384-387. doi: 10.1016/j.amjsurg.201 7.10.045. Epub 2017 Nov 11. PMID: 29157891.
27. Chen MM, Roman SA, Sosa JA, Judson BL. The role of adjuvant therapy in the management of head and neck merkel cell carcinoma: an analysis of 4815 patients. JAMA Otolaryngol Head Neck Surg. 2015 Feb;141(2):137-41. doi: 10.1001/jamao to.2014.3052. PMID: 25474617.
28. Singh B, Qureshi MM, Truong MT, Sahni D. Demographics and outcomes of stage I and II Merkel cell carcinoma treated with Mohs micrographic surgery compared with wide local excision in the National Cancer Database. J Am Acad Dermatol. 2018 Jul;79(1):126-134.e3. doi: 10.1016/j.jaad.2018.01.041. Epub 2018 Feb 3. PMID: 29408552.
29. Koh CS, Veness MJ. Role of definitive radiotherapy in treating patients with inoperable Merkel cell carcinoma: the Westmead Hospital experience and a review of the literature. Australas J Dermatol. 2009 Nov;50(4):249-56. doi: 10.1111/ j.1440-0960.2009.00532.x. PMID: 19916967.
30. Fenig E, Brenner B, Katz A, Rakovsky E, Hana MB, Sulkes A. The role of radiation therapy and chemotherapy in the treatment of Merkel cell carcinoma. Cancer. 1997 Sep 1;80(5):881-5. doi: 10.1002/(sici)1097-0142(19970901)80:5<881::aid-cncr8>3.0.co;2-o. PMID: 9307187.
31. Harrington C, Kwan W. Outcomes of Merkel cell carcinoma treated with radiotherapy without radical surgical excision. Ann Surg Oncol. 2014 Oct;21(11):3401-5. doi: 10.1245/s10434-014-3757-8. Epub 2014 Jul 8. PMID: 25001091.
32. Sims JR, Grotz TE, Pockaj BA, Joseph RW, Foote RL, Otley CC, Weaver AL, Jakub JW, Price DL. Sentinel lymph node biopsy in Merkel cell carcinoma: The Mayo Clinic experience of 150 patients. Surg Oncol. 2018 Mar;27(1):11-17. doi: 10.1016/j.suronc.2017.10.005. Epub 2017 Oct 26. PMID: 29549898.
33. Poulsen MG, Rischin D, Porter I, Walpole E, Harvey J, Hamilton C, Keller J, Tripcony L. Does chemotherapy improve survival in high-risk stage I and II Merkel cell carcinoma of the skin? Int J Radiat Oncol Biol Phys. 2006 Jan 1;64(1):114-9. doi: 10.1016/j.ijrobp.2005.04.042. Epub 2005 Aug 25. PMID: 16125873.
34. D'Angelo SP, Lebbé C, Mortier L, Brohl AS, Fazio N, Grob JJ, Prinzi N, Hanna GJ, Hassel JC, Kiecker F, Georges S, Ellers-Lenz B, Shah P, Güzel G, Nghiem P. First-line avelumab in a cohort of 116 patients with metastatic Merkel cell carcinoma (JAVELIN Merkel 200): primary and biomarker analyses of a phase II study. J Immunother Cancer. 2021 Jul;9(7):e002646. doi: 10.1136/jitc-2021-002646. PMID: 34301810; PMCID: PMC8311489.
35. Nghiem PT, Bhatia S, Lipson EJ, Kudchadkar RR, Miller NJ, Annamalai L, Berry S, Chartash EK, Daud A, Fling SP, Friedlander PA, Kluger HM, Kohrt HE, Lundgren L, Margolin K, Mitchell A, Olencki T, Pardoll DM, Reddy SA, Shantha EM, Sharfman WH, Sharon E, Shemanski LR, Shinohara MM, Sunshine JC, Taube JM, Thompson JA, Townson SM, Yearley JH, Topalian SL, Cheever MA. PD-1 Blockade with Pembrolizumab in Advanced Merkel-Cell Carcinoma. N Engl J Med. 2016 Jun 30;374(26):2542-52. doi: 10.1056/NEJM oa1603702. Epub 2016 Apr 19. PMID: 27093365; PMCID: PMC4927341.
36. Tai PT, Yu E, Winquist E, Hammond A, Stitt L, Tonita J, Gilchrist J. Chemotherapy in neuroendocrine/Merkel cell carcinoma of the skin: case series and review of 204 cases. J Clin Oncol. 2000 Jun;18(12):2493-9. doi: 10.1200/JCO.2000.1 8.12.2493. PMID: 10856110.
37. Iyer JG, Blom A, Doumani R, Lewis C, Tarabadkar ES, Anderson A, Ma C, Bestick A, Parvathaneni U, Bhatia S, Nghiem P. Response rates and durability of chemotherapy among 62 patients with metastatic Merkel cell carcinoma. Cancer Med. 2016 Sep;5(9):2294-301. doi: 10.1002/cam4.815. Epub 2016 Jul 19. PMID: 27431483; PMCID: PMC5055152.
38. Nghiem P, Kaufman HL, Bharmal M, Mahnke L, Phatak H, Becker JC. Systematic literature review of efficacy, safety and tolerability outcomes of chemotherapy regimens in patients with metastatic Merkel cell carcinoma. Future Oncol. 2017 Jun;13(14):1263-1279. doi: 10.2217/fon-2017-0072. Epub 2017 Mar 28. PMID: 28350180; PMCID: PMC6040046.