Merkel Cell Tumor with Spontaneous Regression

O’Rourke, Michael G. E.; Bell, John R.

doi:10.1111/j.1524-4725.1986.tb02143.x

Cited by 74 publications

(46 citation statements)

References 11 publications

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“…[43][44][45] Much of its natural history, diagnosis, and management are still evolving. Because of the relative rarity of this tumor, it precludes a prospective randomized trial to study the intricate roles of surgery, radiation therapy, and chemotherapy in the treatment of this aggressive tumor.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Merkel Cell Carcinoma

Eng¹,

Boersma²,

Fuller³

et al. 2004

American Journal of Clinical Oncology

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Purpose: The purpose of this study was to evaluate the treatment of Merkel cell carcinoma. Materials and Methods: We reviewed 85 cases of Merkel cell carcinoma. There were 68 males and 17 females. The majority of cases involved head and neck sites (48%), followed by the extremities (38%) and trunk (14%). Sixty-seven percent of the patients had stage I disease that was localized to the skin of origin at presentation. Twenty-five percent and 8% were stage II (nodal metastasis) and stage III (distant metastasis), respectively. Surgical intervention included local or wide local excision Ϯ nodal dissection (68%), radical resection Ϯ nodal dissection (22%), and amputation (4%). Five patients (6%) underwent biopsy only because of metastatic disease or unresectability at presentation. Fifty-one percent received adjuvant therapy consisting of external beam radiation therapy and/or combination chemotherapy. Results: With an average follow-up time of 39.5 months, 12% had persistent disease and 40% had recurrent disease. The median time to recurrence was 8 months with a mean of 10.6 months. Although the addition of adjuvant therapy did not affect survival, the recurrence rate was 32.5% for surgery Ϯ adjuvant radiation therapy Ϯ chemotherapy as compared with 52.7% for surgery-only patients. Although the 40.7% recurrence rate for patients receiving surgery and adjuvant radiation therapy was approximately the same as for patients receiving surgery and adjuvant chemotherapy (40%), the effect of systemic chemotherapy on recurrence is less clear as a result of the small number of patients who received such therapy. Although tumor size and site of presentation were not observed to be statistically significant in overall survival, significant differences were observed based on sex and tumor stage. For females, the median survival time was 96 months (mean, 94.5 months) compared with 63 months (mean, 76.8 months) for males. This difference was significant (P Ͻ 0.01). Patients presenting with low-stage (stage I) disease had a significant (P Ͻ 0.01) survival benefit when compared with high-stage individuals (stages II and III). The 5-year actuarial survival rates were 68% and 42%, respectively. Conclusion:In this retrospective study, surgery remains the primary modality for Merkel cell carcinoma, and adjuvant radiation therapy Ϯ systemic chemotherapy reduces local recurrence. Female patients and those who present with early-stage disease appear to have a better prognosis.

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Section: Discussionmentioning

confidence: 99%

Treatment of Merkel Cell Carcinoma

Eng¹,

Boersma²,

Fuller³

et al. 2004

American Journal of Clinical Oncology

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“…Merkel cell carcinoma (MCC) is a rare malignant highly aggressive tumour arising from neuroendocrine cells 1 . Despite the aggressive course of MCC, 11 previous cases of regression in MCC have been reported in the English literature and four additional cases are only available in Japanese 2–9 …”

Section: To the Editormentioning

confidence: 99%

Spontaneous regression in primary cutaneous neuroendocrine (Merkel cell) carcinoma: a rare immune phenomenon?

Sais¹,

Admella

Soler

2002

Acad Dermatol Venereol

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“…[18] At least 30 cases of complete spontaneous regression of MCC have been reported. [19] Even though complete spontaneous regression in MCC is described as extremely rare, these cases constitute approximately 1.4% of all reported cases of MCC (15/1,100).…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Biopsy Does Not Commonly Induce Intratumoral CD8 T Cell Infiltration in Merkel Cell Carcinoma

et al. 2012

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BackgroundMerkel cell carcinoma is a polyomavirus-associated cancer that is strongly linked with T lymphocyte immune suppression in epidemiologic studies. CD8+ T cell infiltration into MCC tumors (intratumoral) has recently been shown to be strongly predictive of improved survival. In contrast, the presence of CD8+ T cells at the border of the tumor (peritumoral) had no independent prognostic value. Spontaneous regression has been reported for MCC approximately one thousand times more often than would be expected given the frequency of this cancer. Many of these events began shortly after biopsy, and in some cases lymphocytic infiltration was described.Methodology/Principal FindingsTo determine whether CD8+ lymphocyte infiltration in MCC tumors is commonly altered by biopsy.33 MCC patients who had microscopic confirmation of MCC on both an initial biopsy and a re-excision specimen were included in this study. Intratumoral and peritumoral CD8 lymphocyte infiltration was quantitated using immunohistochemistry and compared using the paired t-test in biopsy versus re-excision samples. There was a trend toward increased CD8 infiltration after biopsy in a peritumoral (‘stalled’) pattern (p = 0.08), however, biopsy was not associated with a significant increase in CD8 T cells in the clinically more important intratumoral location (p = 0.58).Conclusions/SignificanceThe initial diagnostic biopsy for MCC does not commonly alter intratumoral CD8+ T cell infiltration, suggesting it does not directly induce immunologic recognition of this cancer. Because CD8 infiltration is typically stable after biopsy, this parameter may be useful to assess the efficacy of future immune therapies for this virus-associated, immunogenic, often-lethal cancer.

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Merkel Cell Tumor with Spontaneous Regression

Abstract: Merkel cell tumor of the skin is now a well-documented tumor. We report on another tumor with local recurrence and skin metastases which spontaneously regressed.

Cited by 74 publications

References 11 publications

Treatment of Merkel Cell Carcinoma

Treatment of Merkel Cell Carcinoma

Spontaneous regression in primary cutaneous neuroendocrine (Merkel cell) carcinoma: a rare immune phenomenon?

Diagnostic Biopsy Does Not Commonly Induce Intratumoral CD8 T Cell Infiltration in Merkel Cell Carcinoma

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