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Merkel Cell Carcinoma

Merkel Cell Carcinoma


What is Merkel cell carcinoma?

Merkel cell carcinoma, also called neuroendocrinecancer of the skin, is a rare type of disease in which malignant (cancer) cells are found on or just beneath the skin and in hair follicles. Merkel cell carcinoma usually appears as firm, painless, shiny lumps of skin. These lumps or tumors can be red, pink, or blue in color and vary in size from less than a quarter of an inch to more than two inches. Merkel cell carcinoma is usually found on the sun-exposed areas of the head, neck, arms, and legs. This type of cancer occurs mostly in whites between 60 and 80 years of age, but it can occur in people of other races and ages as well.

Merkel cell carcinoma grows rapidly and often metastasizes (spreads) to other parts of the body. Even relatively small tumors are capable of metastasizing. When the disease spreads, it tends to spread to the regional (nearby) lymph nodes and may also spread to the liver, bone, lungs, and brain. Lymph nodes are small, bean-shaped structures that are found throughout the body. They produce and store infection-fighting cells.

Treatment of Merkel cell carcinoma depends on the stage of the disease, and the patient’s age and overall condition.

Stage Explanation

Stages of Merkel cell carcinoma

After Merkel cell carcinoma has been diagnosed (found), more tests will be done to find out if cancercells have spread from the place the cancer started to other parts of the body. The process used to find out whether the cancer has spread to other parts of the body is called staging. It is important to know the stage of the disease to plan the best treatment. The following stages are used for Merkel cell carcinoma:

Stage I

The primary tumor has not spread to lymph nodes or other parts of the body. Lymph nodes are small, bean-shaped structures that are found throughout the body. They produce and store infection-fighting cells.

Stage II

The cancer has spread to nearby lymph nodes, but has not spread to other parts of the body.

Stage III

The cancer has spread beyond nearby lymph nodes and to other parts of the body.


Recurrent disease means that the cancer has recurred (come back) after it has been treated. It may come back in the same part of the body or in another part of the body.

Treatment Option Overview

How Merkel cell carcinoma is treated

There are treatments for all patients with Merkel cell carcinoma. Three kinds of treatment are used:

There are several different types of surgery that may be used to remove the tumor. These include:

  1. Wide surgicalexcision takes out the cancer and some of the skin around the tumor.

  2. Cryosurgery freezes the tumor and then removes it.

  3. Micrographic surgery (Mohs surgery) is a tissue-sparing technique that removes only the tumor.

Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy).

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in a vein or muscle. Chemotherapy is called a systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body.

If a doctor removes all the cancer that can be seen at the time of the operation, a patient may be given chemotherapy after surgery to kill any cancer cells that are left. Chemotherapy given after an operation to a person who has no cancer cells that can be found is called adjuvant chemotherapy.

Stage I Merkel Cell Carcinoma

Treatment may be one of the following:

  1. Surgery alone.

  2. Surgery followed by radiation therapy to the tumor site and regional lymph nodes.

Stage II Merkel Cell Carcinoma

Treatment may be one of the following:

  1. Surgery alone.

  2. Surgery followed by radiation therapy to the tumor site and regional lymph nodes.

  3. Surgery with or without radiation therapy followed by adjuvant chemotherapy.

Stage III Merkel Cell Carcinoma

Treatment will probably be chemotherapy.

Recurrent Merkel Cell Carcinoma

Treatment may be one of the following:

  1. Surgery alone.

  2. Surgery followed by radiation therapy to the tumor site and regional lymph nodes.

  3. Surgery with or without radiation therapy followed by adjuvant chemotherapy.

Changes to This Summary (07/20/2005)

The PDQcancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Editorial changes were made to this summary, and links to the NCI Dictionary of Cancer Terms were added.

To Learn More


For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.

Web sites and Organizations

The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. There are also many other places where people can get materials and information about cancer treatment and services. Local hospitals may have information on local and regional agencies that offer information about finances, getting to and from treatment, receiving care at home, and dealing with problems associated with cancer treatment.


The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.


The NCI's LiveHelp service, a program available on several of the Institute's Web sites, provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.


For more information from the NCI, please write to this address:

  • NCI Public Inquiries Office

  • Suite 3036A

  • 6116 Executive Boulevard, MSC8322

  • Bethesda, MD 20892-8322

About PDQ

PDQ is a comprehensive cancer database available on NCI's Web site.

PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

PDQ contains cancer information summaries.

The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.

The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.

Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.

PDQ also contains information on clinical trials.

Before starting treatment, patients may want to think about taking part in a clinical trial. A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about new treatments, the risks involved, and how well they do or do not work. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard."

Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

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