About Merkle Cell Carcinoma
Merkel cell carcinoma is an aggressive cancer of the skin that occurs in the elderly and primarily in sun exposed areas. The classic Merkel cell carcinoma is characterized by aggressive local behavior and intradermal metastases. The metastases can appear several centimeters from the area of the original tumor. The diagnosis is made with a simple biopsy. Workup of Merkel cell carcinoma requires imaging with MRI and CT/PET scans and possible sentinel lymph node biopsy.
Treatment of Merkel cell carcinoma inlcudes wide local resection with 1 cm margins. In larger tumors even wider margins such as 2 cm are indicated. Postoperative radiation therapy is frequently required in Merkel cell carcinomas. Merkel cell carcinomas are uniquely radiosensitive and can also be treated primarily with radiation therapy. However, the optimal treatment is surgical resection with postoperative radiation therapy. The hallmark of Merkel cell carcinoma is recurrence several centimeters away from primary treatment site in multiple clusters of intradermal spread.
HISTORY This 69-year-old man presented with greater than 25-year history of multiple basal cell carcinomas of the face and neck. His most problematic cancer has been in the right face. The right facial basal cell carcinoma story that we were able to uncover started 11 years ago with wide local resection of right ear and…Read More
HISTORY 89 year old woman presented in 1/2017 with a lesion on scalp. Biopsy from 12/30/16 first showed squamous cell carcinoma but a second opinion revealed atypical fibroxanthoma. Mohs and reconstruction performed on 1/23/2017, with the core specimen sent for additional analysis which revealed undifferentiated pleomorphic sarcoma. DISCUSSION This 89-year-old woman presented with an exophytic…Read More
HISTORY This 84 year old man was initially seen with a large left facial lesion. Biopsy diagnosed basal cell carcinoma in 3 locations of biopsy. The patient was reluctant to undergo a surgical excision and reconstruction. Vismodegib (Erivedge) was used as primary treatment. Patient completed a 4 month course of 150mg daily vismodegib dose. He…Read More
S-100, tyrosinase, Melan A, and HMB 45 have been the workhorses of melanocyte histopathology. A new immunohistochemical stain, SOX10, has recently been shown to be a useful marker in the diagnosis of melanocytic tumors. It is strongly expressed by desmoplastic melanoma and is less likely to be expressed by background fibrocytes and histiocytes. (review article)…Read More
HISTORY 79 year old man presented in 3/2017 with basal cell carcinoma of the right ear involving the parotid and the tragal cartilage. 3 levels of Mohs were done without clear margins. Mapping biopsies were performed on 3/20/17 showing metatypical basal cell carcinoma with perineural invasion in the parotid but not the facial nerve. On…Read More
HISTORY 75-year-old man presents with a history of recurrent basal cell carcinoma of the nasal tip, previously treated with liquid nitrogen and excised 3-5 years ago. Mohs surgery was performed 7-10-2017 with a 3.2 x 3 cm defect extending from the nasal tip and ala to the mid dorsum. Reconstruction was performed with an extended…Read More
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