TREATING MERKEL CELL CARCINOMA
Once merkel cell carcinoma (MCC) is diagnosed, a CT scan, PET scan, or MRI can be used to see if metastasis has occurred. In order to guide treatment plans, a sentinel lymph node biopsy or lymph node dissection can be used to understand how fast the MCC is growing and spreading.
The treatment plan depends on the MCC stage; however, potential treatments include:
Surgery
- Wide local excision: The MCC skin lesion is removed along with a section of normal tissue around it. This is done when MCC is found within the skin and not in other parts of the body.
- Mohs surgery: Mohs surgery is not standard of care for MCC patients and is decided on a case by case basis and done in very specialized hands. Mohs surgery removes MCC in layers, taking a little away at a time until none is left (i.e., tissue sparing). This is done when leaving as much normal tissue as possible is most advantageous to the patient (e.g., MCC on the face).
- Sentinel node biopsy: Used to determine the need for further dissection of the entire nodal basin and or radiation. The standard of care in MCC is to do a complete dissection if the sentinel node is positive. At this point, the healthcare team and patient can consider radiation alone for patients who cannot tolerate surgery.
- Lymph node dissection: the removal of lymph nodes for a sample of tissue to be examined for signs of cancer. For MCC patients, this is done for those who have palpable nodal disease at presentation. Palpable lymph nodes are lymph nodes that are enlarged enough to be felt by a healthcare provider.
- Regional lymph node dissection: The removal of lymph nodes that are found to have MCC or are located within the tumor area.
Chemotherapy
As with many cancers, the treatment for Merkel Cell Cancer is rapidly evolving. Currently, chemotherapy with cisplatinum and etoposide is typically the first line of treatment for advanced MCC. Chemotherapy drugs are designed to stop the growth of cancer cells, either by destroying them completely, or stopping them from dividing.
Immunotherapy
Immunotherapy is a treatment that boosts your own immune system to fight cancerous cells. Immune checkpoint inhibitors, such as Avelumab, are used to treat advanced MCC, either following chemotherapy, or as the first treatment if chemotherapy is contraindicated.
Clinical Trial Finder
Melanoma Canada’s clinical trial finder connects patients and physicians exploring treatment options with clinical trials, using transformational clinical trial matching technology. Our clinical trial finder uses questionnaires that patients complete to pull clinical trials that are a preliminary match based on diagnosis, stage, etc. Location filters are available to limit to results to your geographic area. Our comprehensive questionnaire helps produce the most accurate clinical trials list for the patient, making the navigation process quick and easy!