Merkel cell carcinoma

Aim The aim of this article was to provide worldwide, population-based incidence rates for Merkel cell carcinoma (MCC). Methods We included 11,576 cases from 20 countries for time trend analyses (1990–2007) and 11,028 cases (2.5 billion person-years) from 21 countries for the period 2003–2007 extracted from Cancer Incidence in Five Continents. We computed age-standardised incidence rates (World Standard population) per million person years and sex ratios of these rates. We estimated annual percentage changes (EAPCs) of the incidence and studied the association between geographic latitude and MCC incidence. We examined the body site distribution of MCC. Findings In the majority of populations, the incidence has increased over time (EAPC, men 2.0–21.0%; women 1.6–27.2%). Rate differences between 1995 and 2007 were typically small (men: 0.8–2.2; women: 0.2–1.7). The incidence was relatively stable in some populations (men: U.S. blacks, Japan, Norway, Denmark; women: Denmark, Norway, Sweden). Incidences from 2003 to 2007 were highest in Australia, New Zealand, the United States and Israel among men and in New Zealand, Australia, Ireland and the Netherlands among women. The incidence of MCC and melanoma among white non-Hispanic males in North America was positively associated with living closer to the equator. The proportion of MCC on the head was higher with advanced age. The head was a less likely primary site among blacks as compared with any other ethnicity. Interpretation Several countries showed increases in MCC incidence among white non-Hispanics over time. Latitude closer to the equator was associated with the MCC incidence in North American men, but barely in women, possibly due to occupational sunlight exposure patterns.

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“…Almost one-third of patients present at primary diagnosis with loco-regional metastases, e.g. in transit or lymph node metastases [1]. …”

Section: Introductionmentioning

confidence: 99%

The association between geographic location and incidence of Merkel cell carcinoma in comparison to melanoma: An international assessment

Stang

Becker²,

Nghiem

et al. 2018

European Journal of Cancer

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104

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“…Immune evasion is an established hallmark of cancer . Importantly, immune evasion mechanisms have become the focus of current investigations aiming at therapeutic targeting of Merkel cell carcinoma (MCC), a rare but highly aggressive skin cancer with neuroendocrine features . A viral etiology characterized by the presence of Merkel cell polyomavirus (MCV) as well as chronic exposure to solar ultraviolet light have been identified as key factors driving the majority of MCC cases, characterized by solitary cutaneous or subcutaneous nodules.…”

Section: Tlr4 In Merkel Cell Carcinomamentioning

confidence: 99%

“…A viral etiology characterized by the presence of Merkel cell polyomavirus (MCV) as well as chronic exposure to solar ultraviolet light have been identified as key factors driving the majority of MCC cases, characterized by solitary cutaneous or subcutaneous nodules. Photoimmunosuppression and photomutagenesis, associated with solar UV exposure, have been mechanistically implicated in both viral and nonviral mediated MCC …”

Section: Tlr4 In Merkel Cell Carcinomamentioning

confidence: 99%

TLR4 in skin cancer: From molecular mechanisms to clinical interventions

Dickinson

Wondrak

2019

Molecular Carcinogenesis

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The health and economic burden imposed by skin cancer is substantial, creating an urgent need for the development of improved molecular strategies for its prevention and treatment. Cutaneous exposure to solar ultraviolet (UV) radiation is a causative factor in skin carcinogenesis, and TLR4‐dependent inflammatory dysregulation is an emerging key mechanism underlying detrimental effects of acute and chronic UV exposure. Direct and indirect TLR4 activation, upstream of inflammatory signaling, is elicited by a variety of stimuli, including pathogen‐associated molecular patterns (such as lipopolysaccharide) and damage‐associated molecular patterns (such as HMGB1) that are formed upon exposure to environmental stressors, such as solar UV. TLR4 involvement has now been implicated in major types of skin malignancies, including nonmelanoma skin cancer, melanoma and Merkel cell carcinoma. Targeted molecular interventions that positively or negatively modulate TLR4 signaling have shown promise in translational, preclinical, and clinical investigations that may benefit skin cancer patients in the near future.

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“…1 MCC has a higher mortality rate than malignant melanoma, with up to 30-40% of patients dying from their disease. 1 MCC has a higher mortality rate than malignant melanoma, with up to 30-40% of patients dying from their disease.…”

Section: Introductionmentioning

confidence: 99%

Sentinel lymph node biopsy in clinically node‐negative Merkel cell carcinoma: the Westmead Hospital experience

Jenkins

Howle

Veness

2019

ANZ Journal of Surgery

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Background: Merkel cell carcinoma (MCC) is a rare, aggressive cutaneous malignancy with a propensity to metastasize to regional lymph nodes. Sentinel lymph node biopsy (SLNB) in patients with clinically node-negative MCC has been utilized to identify patients with subclinical nodal metastases. This study aims to review the accuracy of SLNB in MCC and to evaluate the impact of SLNB on management. Methods: Patients with clinically node-negative MCC who underwent SLNB were identified from a prospective database of patients treated at the Westmead Hospital, Sydney, between 1998 and 2017. Data from these patients were reviewed and analysed. Results: Forty-one patients were identified: 28 men and 13 women, median age 70 years. Median duration of follow-up was 27 months. Sixteen (39%) patients had a positive SLNB and all underwent nodal treatment which consisted of radiotherapy (n = 13), completion lymphadenectomy and adjuvant radiotherapy (n = 2), and completion lymphadenectomy alone (n = 1). Following negative SLNB, 24 of 25 patients did not undergo further nodal treatment. The false-negative rate was 16% as three patients developed in-field nodal recurrence subsequent to a negative SLNB. At last follow-up, 29 patients had no evidence of disease, six were alive with disease and three had died from other causes. Three SLN-positive patients have died of MCC. Conclusion: SLNB has a high rate of positivity and can improve the accuracy of staging and prognostication in MCC, and guide management. The relatively low risk of a falsenegative SLNB justifies close observation in SLNB-negative patients.

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Merkel cell carcinoma

Cited by 465 publications

References 173 publications

The association between geographic location and incidence of Merkel cell carcinoma in comparison to melanoma: An international assessment

The association between geographic location and incidence of Merkel cell carcinoma in comparison to melanoma: An international assessment

TLR4 in skin cancer: From molecular mechanisms to clinical interventions

Sentinel lymph node biopsy in clinically node‐negative Merkel cell carcinoma: the Westmead Hospital experience

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