Merkel cell carcinoma (MCC) is an aggressive skin cancer that recurs in more than one-third of cases, with reported mortality rates of 33% to 46%.1 Given this high-risk situation, MCC is often managed with therapies that are aggressive and potentially toxic: extensive surgery, radiation therapy (RT), and systemic therapy. Fortunately, recent advances in multiple realms now allow MCC management to be more effective and less toxic. In this Viewpoint, we highlight 3 recent developments relating to progress in local management, early detection of recurrent disease, and systemic therapy. Although it is not practical for physicians who rarely see patients with MCC to remain up-to-date on the details of management, herein we provide resources and guidelines to help physicians ensure optimal initial care and participate in longitudinal treatment of patients with MCC.
Merkel cell carcinoma can be indolent: A case with 7 locoregional recurrences over 15 years highlights the importance of patient-tailored management
Patients who experience a recurrence of their Merkel cell carcinoma are often treated aggressively. We report a case of a man with an unusually long course of MCC over 15 years who had his MCC recur around his face or neck 7 times before eventually developing distant spread. Because he had 4 major medical problems at the time his MCC initially appeared, less aggressive therapies were chosen for his recurrences, and there was no evidence of disease for the vast majority of his 15-year course, during which he enjoyed excellent quality of life. This case emphasizes the importance of customizing care in MCC to give patients the best quality and quantity of life possible in their particular situation.