Rare carcinoma on the rise

Q. Would you please write a column about Merkel cell carcinoma? I was diagnosed with this and understand the enormity of it. There is a lack of knowledge about it in medical circles as well as the general population. I feel people need to be made aware of Merkel cell, its symptoms, treatment and survival rates.

I find myself in the fight for my life all because no one recognized a small pencil-point-sized imperfection on my face as Merkel cell carcinoma. Please write a column and make everyone aware of this horrible condition.

A. Merkel cell is relatively complex, as are most cancers, and, because I am not a dermatologist or oncologist, I will provide general information only.

Merkel cell carcinoma (also known as neuroendocrine carcinoma of the skin) is a rare skin cancer. It is usually fast-growing and can spread quickly to other parts of the body. As with other skin cancers, the number of cases is on the rise.

The first symptom is generally a fast-growing, painless bump on the skin, which often appears on the face, head or neck but can occur anywhere on the body. It is usually shiny and may be flesh-colored, red, blue or purple. If unchecked, the cancer can spread, leading to swollen lymph glands, fatigue or pain. It is important to have any suspicious lesion checked out by a physician, who may biopsy it.

The cause of Merkel cell carcinoma is unknown, but there are two leading theories. One is that the cancer arises directly from the Merkel cell, which lies in the outermost layer of skin, and the other is that certain immature skin stem cells become cancerous and develop features that resemble Merkel cells.

There are several risk factors for developing this type of cancer. As with all others, unprotected exposure to natural or artificial sunlight is one of the leading links. Others include age, having light-colored skin or a weakened immune system, or having a history of other types of skin cancer.

There are several treatments available. Several factors come into play when your oncologist is coming up with a plan. The size and location of the lesion are important. Determining whether the cancer has spread and, if so, to what extent is also vital. Small lesions that have not spread can generally be removed by surgically excising the lesion and a portion of the surrounding healthy skin. You may need to follow up the surgery with radiation to ensure that all cancer cells were removed or obliterated. Radiation can also be used to shrink the size of the tumor before surgery or as sole treatment in those who refuse surgery. For recurrent or metastasized Merkel cell, chemotherapy may be used.

People with skin cancer should be under the care of an oncologist, who can monitor and treat the lesions. Once skin cancer is present, the risk of developing more lesions or other types increases, so it is vital to be vigilant about sun protection and self-checking for new or changing lesions on the body.

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