Transcript Merkel*s Cell Carcinoma

J.M.
21 y/o female
cc: scalp mass
History of Present Illness
14 years
PTA
• Slowly enlarging, firm,
occasionaly tender mass on R
parietoocipital area (3x3cm)
• Consult
– A: Hemangioma
– P: Excision
2 mos
PTA
• Recurrence of slowly
enlarging mass (5x5cm)
• Consult at UST OPD
– Scalp X Ray
– Ultrasound of neck
ADMISSION
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(-) HPN
(-) DM
(-) HPV infection
(-) Asthma
(-) Allergies
(-) PTB
• Mixed diet
• Nonsmoker
• Not an alcoholic beverage drinker
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(+) HPN – mother
(+) DM – grandfather
(-) Asthma
(-) CA
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(-) weight loss, weakness, fatigue
(-) Headache, dizziness, blurring of vision
(-) hearing loss, aural discharge, tinnitus
(-) epistaxis, nasal discharge, sinusitis
(-) hoarseness, mouth sores, dysphagia
(-) dyspnea, cough
• Conscious, coherent, ambulatory, not in distress
• BP: 120/80 PR 80bpm RR 18cpm
T 36.5°C
Wt. 60 kg
Ht. 162cm
• Warm moist skin, no active dermatoses
• Pink palpebral conjunctivae, anicteric sclerae
• No naso-aural discharge, non-congested turbinates,
non-tender sinus, buccal mucosa, tonsils not
enlarged, no bleeding gums
• Supple neck, (-) palpable cervical Lymph Nodes, no
thyromegaly
• Symmetric on chest expansion, (-) retractions,
lungs resonant, clear breath sounds
• Adynamic precordium, AB 5th LICS MCL, S1>S2
at the apex, S2>S1 at the base, no murmurs
• Flat abdomen, no organomegaly, (-) rebound
tenderness, no masses
• (-) pallor, clubbing, petechiae, ecchymoses
• Pulses ++ on all extremities
Admitting Impression
• Soft tissue tumor to consider recurrent
hemangioma vs. granuloma
Merkel’s Cell Carcinoma
• Classified as a neuroendocrine malignancy of
the skin.
• Cutaneous small cell undifferentiated
carcinoma
• Incidence of 1200 per year in the US
• Mortality rate of 33 %
National Cancer Institute. Fact Sheet MERKEL’S CARCINOMA. 2007
Merkel Cell Carcinoma: More Deathsbut Still No Pathway to Blame Bianca Lemos and Paul Nghiem. Journal of Investigative Dermatology
(2007)
Discussion
• Merkel’s cells located in the basal layer of the
epidermis.
• Grossly, the primary tumor presents as a
small, red, pink, or blue-violet, non-ulcerated,
painless, intradermal nodular mass often
located in sun-exposed areas of the skin such
as the head and neck
Discussion
• Neuroendocrine markers
– Neuron-specific enolase
– Chromogranin
– Synaptopysin
Merkel cell carcinoma, Virve Koljonen. World Journal of Surgical Oncology 2006
American Joint Committee on Cancer
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Stage I (primary lesion ≤ 2 cm)
Stage II (primary lesion > 2 cm).
Stage III (nodal involvement)
Stage IV disease (metastatic)
Prognosis
• Aggressive course with reported overall 5-year
survival rates ranging from 30% to 64%.
• Survival after a diagnosis of MCC is highly
dependent on the stage at presentation.
• 90 percent of recurrences occurring within
three years of diagnosis
Merkel Cell Carcinoma: A Case Report and Literature Review. Oncology. Medical Journal of Islamic World
Academy of Sciences 15:3, 91-94, 2005