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Esser E, Grünewald I, Mihailovic N. [Periocular Merkel Cell Carcinoma - an overview of clinical aspects and current therapeutic options]. Laryngorhinootologie 2024; 103:404-412. [PMID: 38128577 DOI: 10.1055/a-2214-5209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Merkel cell carcinoma (MCC) is a rare but highly aggressive and rapidly expanding malignant skin tumor. It affects the periocular region in approximately 10% of cases. The current treatment recommendation for resectable non-metastatic MCC comprises total surgical excision; however, lymph node or distant metastases are often already present by the time of the diagnosis. Since an immune checkpoint inhibitor therapy with avelumab was first approved for MCC in 2016, there has been considerable improvement in mean survival compared to cytostatic therapy; at the same time, there has been a reduction in serious treatment-associated adverse events. Other immune checkpoint inhibitors are currently still in clinical trials, with very promising initial results. Because of the complexity of the diagnosis, treatment, and prognosis, it is essential that MCC patients receive interdisciplinary care in a specialized center including consultation with a tumor review board.
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Affiliation(s)
- Eliane Esser
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Munster, Germany
| | - Inga Grünewald
- Gerhard-Domagk-Institut für Pathologie, Universitätsklinikum Münster, Münster, Germany
| | - Natasa Mihailovic
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Münster, Germany
- Klinik für Augenheilkunde, Klinikum Fulda gAG, Fulda, Germany
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Schatten H, Gaca PJ, Tolkach Y, Heindl LM, Doulis AE. [Rapidly growing, highly vascularized upper eyelid tumor]. DIE OPHTHALMOLOGIE 2023; 120:954-956. [PMID: 36473989 DOI: 10.1007/s00347-022-01767-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 10/21/2022] [Accepted: 11/02/2022] [Indexed: 06/17/2023]
Affiliation(s)
- Hannah Schatten
- Zentrum für Augenheilkunde, Universität zu Köln, Köln, Deutschland.
| | - Piotr Jakub Gaca
- Zentrum für Augenheilkunde, Universität zu Köln, Köln, Deutschland
| | - Yuri Tolkach
- Institut für Pathologie, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
| | - Ludwig M Heindl
- Zentrum für Augenheilkunde, Universität zu Köln, Köln, Deutschland
- Centrum für Integrierte Onkologie (CIO) Aachen-Bonn-Köln-Düsseldorf, Köln, Deutschland
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Schultz E. [Merkel Cell Carcinoma]. Laryngorhinootologie 2023. [PMID: 36693386 DOI: 10.1055/a-1949-3751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Merkel cell carcinoma represents a neuroendocrine tumour which can grow rapidly and metastasizes early. The median age of patients is 75-80 years. Given the continuously rising population age Merkel cell carcinoma is diagnosed more often. Besides surgery, radiotherapy and chemotherapy immunooncology plays an important role in the treatment of this aggressive tumour.
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Esser E, Grünewald I, Mihailovic N. Periocular Merkel Cell Carcinoma - An Overview of Clinical Aspects and Current Treatment Options. Klin Monbl Augenheilkd 2023; 240:24-32. [PMID: 36368663 DOI: 10.1055/a-1925-7703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Merkel cell carcinoma (MCC) is a rare but highly aggressive and rapidly expanding malignant skin tumor. It affects the periocular region in approximately 10% of cases. The current treatment recommendation for resectable non-metastatic MCC comprises total surgical excision; however, lymph node or distant metastases are often already present by the time of the diagnosis. Since an immune checkpoint inhibitor therapy with avelumab was first approved for MCC in 2016, there has been considerable improvement in mean survival compared to cytostatic therapy; at the same time, there has been a reduction in serious treatment-associated adverse events. Other immune checkpoint inhibitors are currently still in clinical trials, with very promising initial results. Because of the complexity of the diagnosis, treatment, and prognosis, it is essential that MCC patients receive interdisciplinary care in a specialized center including consultation with a tumor review board.
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Affiliation(s)
- Eliane Esser
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Deutschland
| | - Inga Grünewald
- Gerhard-Domagk-Institut für Pathologie, Universitätsklinikum Münster, Deutschland
| | - Natasa Mihailovic
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Deutschland.,Klinik für Augenheilkunde, Klinikum Fulda gAG, Deutschland
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Silling S, Kreuter A, Gambichler T, Meyer T, Stockfleth E, Wieland U. Epidemiology of Merkel Cell Polyomavirus Infection and Merkel Cell Carcinoma. Cancers (Basel) 2022; 14:6176. [PMID: 36551657 PMCID: PMC9776808 DOI: 10.3390/cancers14246176] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/06/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022] Open
Abstract
Merkel cell polyomavirus (MCPyV) is a ubiquitous virus replicating in human dermal fibroblasts. MCPyV DNA can be detected on healthy skin in 67−90% of various body sites, and intact virions are regularly shed from the skin. Infection occurs early in life, and seropositivity increases from 37 to 42% in 1- to 6-year-olds to 92% in adults. Merkel cell carcinoma (MCC) is a rare but very aggressive neuroendocrine tumor of the skin. It develops mainly on sun-exposed areas as a fast-growing, reddish nodule. Two MCC entities exist: about 80% of MCC are MCPyV-associated. Tumorigenesis is driven by viral integration into the host genome and MCPyV oncogene expression. In MCPyV-negative MCC, UV radiation causes extensive DNA damage leading to the deregulation of the cell cycle. In recent decades, MCC incidence rates have increased worldwide, e.g., in the United States, from 0.15 in 1986 to 0.7/100,000 in 2016. Risk factors for the development of MCC include male sex, older age (>75 years), fair skin, intense UV exposure, and immunosuppression. Projections suggest that due to aging populations, an increase in immunosuppressed patients, and enhanced UV exposure, MCC incidence rates will continue to rise. Early diagnosis and prompt treatment are crucial to reducing high MCC morbidity and mortality.
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Affiliation(s)
- Steffi Silling
- Institute of Virology, National Reference Center for Papilloma- and Polyomaviruses, Faculty of Medicine, University Hospital Cologne, 50935 Cologne, Germany
| | - Alexander Kreuter
- Department of Dermatology, Venereology and Allergology, HELIOS St. Elisabeth Hospital Oberhausen, University Witten/Herdecke, 58455 Witten, Germany
| | - Thilo Gambichler
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Thomas Meyer
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Eggert Stockfleth
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Ulrike Wieland
- Institute of Virology, National Reference Center for Papilloma- and Polyomaviruses, Faculty of Medicine, University Hospital Cologne, 50935 Cologne, Germany
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Hage SM, Burbach G, Harth W. ZNS- und Nebennierenmetastasen bei Merkelzellkarzinom – ein besonderer Fall. AKTUELLE DERMATOLOGIE 2022. [DOI: 10.1055/a-1875-0597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
ZusammenfassungDas Merkelzellkarzinom ist ein hochaggressiver, seltener Hauttumor. Bei Erstdiagnose bestehen bereits bei 30% der Patienten loko-regionäre Lymphknotenmetastasen. Fernmetastasen finden sich häufig in entfernten Lymphknotenstationen, der Haut, den abdominellen Organen und den Knochen. Bei Auftreten von Fernmetastasen reduziert sich das 5-Jahres-Überleben auf 18%. Wir berichten über eine Patientin mit Merkelzellkarzinom, die ein Jahr nach Erstdiagnose Fernmetastasen im ZNS und den Nebennieren entwickelte. Beide Lokalisationen sind bisher selten beschrieben. Therapeutisch kamen Radiatio, Radiochirurgie und eine Immuntherapie mit Avelumab zum Einsatz. Während sich hierunter eine komplette Remission der Hirnfiliae zeigte, führte ein rasanter Progress der Nebennierenmetastasen zur Umstellung auf eine palliative platinbasierte Chemotherapie.
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Affiliation(s)
- Sina-Maria Hage
- Klinik für Dermatologie und Allergologie, Vivantes Klinikum Spandau, Berlin, Deutschland
- Praxis für Dermatologie, Vivantes MVZ Spandau, Berlin, Deutschland
| | - Guido Burbach
- Klinik für Dermatologie und Allergologie, Vivantes Klinikum Spandau, Berlin, Deutschland
- Praxis für Dermatologie, Vivantes MVZ Spandau, Berlin, Deutschland
| | - Wolfgang Harth
- Klinik für Dermatologie und Allergologie, Vivantes Klinikum Spandau, Berlin, Deutschland
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Roschinski B, Werner M, Mittelviefhaus H, Auw-Hädrich C. Merkel Cell Carcinoma of the Upper Eye Lid with Atypical Clinical Appearance. Klin Monbl Augenheilkd 2022; 239:899-904. [PMID: 35858601 DOI: 10.1055/a-1864-9772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Merkel cell carcinoma (MCC) is a rare aggressive neuroendocrine skin tumor that occurs mainly in the sun-exposed head and neck region, but rarely in the eyelid region. Early lymphogenic spread often leads to locoregional metastases, which is why early diagnosis is crucial. Classically, periocular MCC presents as a reddish-livid nodule in elderly patients, a visual diagnosis. However, given its low incidence and variable appearance, diagnosis can also be challenging. In both cases presented here, the MCC presented as a skin-colored swelling. In patient 1, the tumor showed a partially deep subaponeurotic localization and mimicked a B-cell lymphoma histopathologically, whereas in patient 2 it imitated a diffuse chalazion clinically. After immunohistochemical characterization and exclusion of metastases, the initial clinically benign appearing lesions in both patients were classified as CK20 negative MCC. The extensive upper eyelid defects were reconstructed by Cutler-Beard plastic surgery, a particular challenge in patient 1 given the oculus unicus situation. Our two cases demonstrate that Merkel cell carcinomas not only manifest as deep red cherry-shaped tumors, but can be skin-colored and mimic benign changes when atypical in location or infiltration pattern.
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Affiliation(s)
| | - Martin Werner
- Institut für klinische Pathologie, Universitätsklinikum Freiburg, Deutschland
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Schultz ES. Merkelzellkarzinom. AKTUELLE DERMATOLOGIE 2022. [DOI: 10.1055/a-1739-4701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfassungDas Merkelzellkarzinom ist ein aggressiver neuroendokriner Tumor, welcher durch schnelles Wachstum und frühzeitige Metastasierung charakterisiert ist. Das mediane Erkrankungsalter liegt zwischen 75–80 Jahren. Mit Zunahme des durchschnittlichen Bevölkerungsalters tritt der einstmals seltene Tumor immer häufiger auf. Neben den klassischen Therapiesäulen Chirurgie, Strahlentherapie und Chemotherapie spielt die Immunonkologie auch beim Merkelzellkarzinom eine zunehmend wichtige Rolle.
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Affiliation(s)
- Erwin S. Schultz
- Klinik für Dermatologie, Klinikum Nürnberg – Paracelsus Medizinische Privatuniversität, Nürnberg
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