Clinical case: successful treatment of Merkel cell carcinoma in an 84-year-old patient
https://doi.org/10.18699/SSMJ20250118
Abstract
Merkel cell carcinoma is a rare tumour characterized by a high potential for metastasis and local recurrence. The nonspecific clinical picture of the disease often leads to late diagnosis, which creates certain difficulties in the further management of patients. The predominant number of patients with Merkel cell carcinoma are elderly and senile persons, whose comorbid status requires a personalized approach to treatment. This article presents a clinical observation of successful treatment of an 84-year-old woman with Merkel cell carcinoma of the infraorbital region. The patient came to the clinic with complaints of a skin tumor in the infraorbital region on the right, which was verified at her place of residence as Merkel carcinoma. Computer tomography additionally found a focal mass in the right parotid gland. Additional examination revealed no contraindications to surgical treatment, after which the patient underwent wide excision of the skin tumor with a reconstructive plastic component, extended cervical lymph node dissection with resection of the parotid salivary gland on the right. Histological examination of postoperative material confirmed the diagnosis. Subsequently, the patient underwent a postoperative course of radiation therapy. No information on recurrence of the disease was received at the time of submission of data for publication. Treatment of Merkel cell carcinoma in elderly patients requires a multidisciplinary approach and can significantly improve the quality of life.
About the Authors
E. E. BabykhinRussian Federation
Evgeniy E. Babykhin
3055241; Eliseeva st., 1; Kursk region; farm Kislino
V. V. Khvostovoi
Russian Federation
Vladimir V. Khvostovoi, candidate of medical sciences
3055241; Eliseeva st., 1; Kursk region; farm Kislino; 305006; Karla Marksa st., 3; Kursk
K. E. Kelyamova
Russian Federation
Karina E. Kelyamova
305006; Karla Marksa st., 3; Kursk
E. D. Tsnobiladze
Russian Federation
Eduard D. Tsnobiladze
3055241; Eliseeva st., 1; Kursk region; farm Kislino
A. I. Klementyeva
Russian Federation
Alena I. Klementyeva
3055241; Eliseeva st., 1; Kursk region; farm Kislino; 305006; Karla Marksa st., 3; Kursk
S. Yu. Shumakova
Russian Federation
Svetlana Yu. Shumakova
3055241; Eliseeva st., 1; Kursk region; farm Kislino
References
1. Becker J.C., Stang A., DeCaprio J.A., Cerroni L., Lebbé C., Veness M., Nghiem P. Merkel cell carcinoma. Nat. Rev. Dis. Primers. 2017;3:17077. doi: 10.1038/nrdp.2017.77
2. Rebrova D.V., Malyshenko Yu.A., Savel’eva T.V., Rudyuk L.A., Mityukov A.E., Ivonina E.V., Soroko I.V., Chernikov R.A., Sleptsov I.V., Vorokhobina N.V. Merkel cell carcinoma with adrenal metastasis: a clinical case. Rossiyskiy onkologicheskiy zhurnal = Russian Journal of Oncology. 2023;28(3):145–154. [In Russian]. doi: 10.17816/onco624319
3. Pietropaolo V., Prezioso C., Moens U. Merkel cell polyomavirus and merkel cell carcinoma. Cancers (Basel). 2020;12(7):1774. doi: 10.3390/cancers12071774
4. Feng H., Shuda M., Chang Y., Moore P.S. Clonal integration of a polyomavirus in human Merkel cell carcinoma. Science. 2008;319(5866):1096–1100. doi: 10.1126/science.1152586
5. Wong S.Q., Waldeck K., Vergara I.A., Schröder J., Madore J., Wilmott J.S., Colebatch A.J., de Paoli-Iseppi R., Li J., Lupat R., … Tothill R.W. UV-associated mutations underlie the etiology of MCV-negative Merkel cell carcinomas. Cancer Res. 2015;75(24):5228–5234. doi: 10.1158/0008-5472.CAN-15-1877
6. Zhu Y., Yin Y., Li F., Ren Z., Dong Y. A review on the oncogenesis of Merkel cell carcinoma: Several subsets arise from different stages of differentiation of stem cell. Medicine (Baltimore). 2023;102(15):e33535. doi: 10.1097/MD.0000000000033535
7. Harms K.L., Zhao L., Johnson B., Wang X., Carskadon S., Palanisamy N., Rhodes D.R., Mannan R., Vo J.N., Choi J.E., … Harms P.W. Virus-positive Merkel cell carcinoma is an independent prognostic group with distinct predictive biomarkers. Clin. Cancer Res. 2021;27(9):2494–2504. doi: 10.1158/1078-0432.CCR-20-0864
8. Engels E.A., Frisch M., Goedert J.J., Biggar R.J., Miller R.W. Merkel cell carcinoma and HIV infection. Lancet. 2002;359(9305):497–498. doi: 10.1016/S0140-6736(02)07668-7
9. Clarke C.A., Robbins H.A., Tatalovich Z., Lynch C.F., Pawlish K.S., Finch J.L., Hernandez B.Y., Fraumeni J.F. Jr., Madeleine M.M., Engels E.A. Risk of Merkel cell carcinoma after solid organ transplantation. J. Natl. Cancer Inst. 2015;107(2):dju382. doi: 10.1093/jnci/dju382
10. Koljonen V., Kukko H., Pukkala E., Sankila R., Böhling T., Tukiainen E., Sihto H., Joensuu H. Chronic lymphocytic leukaemia patients have a high risk of Merkel-cell polyomavirus DNA-positive Merkel-cell carcinoma. Br. J. Cancer. 2009;101(8):1444–1447. doi: 10.1038/sj.bjc.6605306
11. Koljonen V., Rantanen M., Sahi H., Mellemkjær L., Hansen B.T., Chen T., Hemminki K., Pukkala E. Joint occurrence of Merkel cell carcinoma and non-Hodgkin lymphomas in four Nordic countries. Leuk. Lymphoma. 2015;56(12):3315–3319. doi: 10.3109/10428194.2015.1040010
12. Hemminki K., Liu X., Ji J., Sundquist J., Sundquist K. Kaposi sarcoma and Merkel cell carcinoma after autoimmune disease. Int. J. Cancer. 2012;131(3):E326–E328. doi: 10.1002/ijc.27376
13. Sridharan V., Muralidhar V., Margalit D.N., Tishler R.B., DeCaprio J.A., Thakuria M., Rabinowits G., Schoenfeld J.D. Merkel cell carcinoma: a population analysis on survival. J. Natl. Compr. Cancer Netw. 2016;14(10):1247–1257. doi: 10.6004/jnccn.2016.0134
14. Sunshine J.C., Jahchan N.S., Sage J., Choi J. Are there multiple cells of origin of Merkel cell carcinoma? Oncogene. 2018;37(11):1409–1416. doi: 10.1038/s41388-017-0073-3
15. Heath M., Jaimes N., Lemos B., Mostaghimi A., Wang L.C., Peñas P.F., Nghiem P. Clinical characteristics of Merkel cell carcinoma at diagnosis in 195 patients: the AEIOU features. J. Am. Acad. Dermatol. 2008;58(3):375–381. doi: 10.1016/j.jaad.2007.11.020
16. Albores-Saavedra J., Batich K., Chable-Montero F., Sagy N., Schwartz A.M., Henson D.E. Merkel cell carcinoma demographics, morphology, and survival based on 3870 cases: a population based study. J. Cutan. Pathol. 2010;37(1):20–27. doi: 10.1111/j.1600-0560.2009.01370.x
17. Yusuf M.B., McKenzie G., Rattani A., Tennant P., Bumpous J., Miller D., Dunlap N. Merkel cell carcinoma of the head and neck: epidemiology, pathogenesis, current state of treatment and future directions. Cancers (Basel). 2021;13(14):3506. doi: 10.3390/cancers13143506
18. Gauci M.L., Aristei C., Becker J.C., Blom A., Bataille V., Dreno B., Del Marmol V., Forsea A.M., Fargnoli M.C., Grob J.J., … European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO) and the European Organization for Research and Treatment of Cancer (EORTC). Diagnosis and treatment of Merkel cell carcinoma: European consensus-based interdisciplinary guideline – Update 2022. Eur. J. Cancer. 2022;171:203–231. doi: 10.1016/j.ejca.2022.03.043
19. Andruska N., Fischer-Valuck B.W., Mahapatra L., Brenneman R.J., Gay H.A., Thorstad W.L., Fields R.C., MacArthur K.M., Baumann B.C. Association between surgical margins larger than 1 cm and overall survival in patients with Merkel cell carcinoma. JAMA Dermatol. 2021;157(5):540–548. doi: 10.1001/jamadermatol.2021.0247
20. Yan L., Sun L., Guan Z., Wei S., Wang Y., Li P. Analysis of cutaneous Merkel cell carcinoma outcomes after different surgical interventions. J. Am. Acad. Dermatol. 2020;82(6):1422–1434. doi: 10.1016/j.jaad.2018.10.001
21. Fields R.C., Busam K.J., Chou J.F., Panageas K.S., Pulitzer M.P., Allen P.J., Kraus D.H., Brady M.S., Coit D.G. Five hundred patients with Merkel cell carcinoma evaluated at a single institution. Ann. Surg. 2011;254(3):465–475. doi: 10.1097/SLA.0b013e31822c5fc1
22. Utyashev I.A., Kramchaninov M.M., Orlova K.V., Mudunov A.M., Trofimova O.P., Petenko N.N., Zinoviev G.V., Nazarova V.V. Practical recommendations for the drug treatment of malignant non-melanocytic skin tumors (basal cell skin cancer, squamous cell skin cancer, Merkel cell carcinoma). Zlokachestvennye opukholi = Malignant Tumors. 2022;12(3s2-1):672–696. [In Russian]. doi: 10.18027/2224-5057-2022-12-3s2-672-696
23. Clinical recommendations. Merkel cell carcinoma. Moscow, 2020. 79 p. [In Russian].
24. Ermilov V.V., Zagrebin V.L., Barkanov V.B., Markelov V.V., Mikailzade G.F. Morphological features and modern strategies of treatment of Merkel cell carcinoma. Vestnik Volgogradskogo gosudarstvennogo meditsinskogo universiteta = Journal of the Volgograd State Medical University. 2020;(1):3–9. [In Russian]. doi: 10.19163/1994-9480-2020-1(73)-3-9
25. Sihto H., Böhling T., Kavola H., Koljonen V., Salmi M., Jalkanen S., Joensuu H. Tumor infiltrating immune cells and outcome of Merkel cell carcinoma: a population-based study. Clin. Cancer Res. 2012;18(10):2872–2881. doi: 10.1158/1078-0432.CCR-11-3020
26. Paulson K.G., Iyer J.G., Simonson W.T., Blom A., Thibodeau R.M., Schmidt M., Pietromonaco S., Sokil M., Warton E.M., Asgari M.M., Nghiem P. CD8+ lymphocyte intratumoral infiltration as a stage-independent predictor of Merkel cell carcinoma survival: a population-based study. Am. J. Clin. Pathol. 2014;142(4):452–458. doi: 10.1309/AJCPIKDZM39CRPNC
27. Narisawa Y., Koba S., Inoue T., Nagase K. Histogenesis of pure and combined Merkel cell carcinomas: an immunohistochemical study of 14 cases. J. Dermatol. 2015;42(5):445–452. doi: 10.1111/1346-8138.12808
Review
For citations:
Babykhin E.E., Khvostovoi V.V., Kelyamova K.E., Tsnobiladze E.D., Klementyeva A.I., Shumakova S.Yu. Clinical case: successful treatment of Merkel cell carcinoma in an 84-year-old patient. Сибирский научный медицинский журнал. 2025;45(1):165-173. (In Russ.) https://doi.org/10.18699/SSMJ20250118