Clinical features and management of Merkel cell carcinoma

Merkel cell carcinoma (MCC) is an aggressive dermal tumour of neuroendocrine origin. MCC is a rare tumour and all information pertaining to its behaviour, therapy and prognosis is based on retrospective reports. The two potentially curative treatment modalities are surgery and radiotherapy. It is a rare, highly malignant primary skin tumour, originally called trabecular carcinoma of the skin. MCC poses a challenge to the clinician because of its rarity and poor prognosis. The optimal therapy is customised and tailored for each individual patient with the appropriate use of operative resection and radiation therapy. This review covers reports from several authors regarding the rationale of using postoperative radiotherapy to the primary tumour and regional lymphatics. Although MCC is classified as a type of neuroendocrine carcinoma, it is less likely to be controlled by systemic chemotherapy. Management of primary lesion with clinically localised disease is wide excision with margin of at least 2 cm whenever possible. MCC is a radiosensitive tumour, adjuvant radiotherapy has been advocated in order to control local as well as regional disease. Radiation induced toxicity should be considered and discussed with the patient. Adjuvant radiation to the nodal bed after complete lymphadenectomy in patients with metastatic disease is generally not recommended

Latest update on the clinical features and management of Merkel cell carcinoma

Merkel cell carcinoma (MCC), is a rare, highly malignant skin tumour, with a poor prognosis. Though the aetiology of MCC is not known, but there are several features that it shares with melanoma. These include the natural history, clinical features and behaviour, e.g. an early spread to nodal sites, high local recurrence rate and early metastasis. Incidence of MCC is seen to be increased in immunosuppressed transplant patients, in patients with rheumatoid arthritis and in B cell malignancies, with a strong male predominance. Despite the ongoing research and advancement, MCC yet poses a challenge to the clinicians because of its rarity. The purpose of this paper is to review the most salient and clinically relevant updates of MCC since its first publication in July 2007 in JPMA. In order to expedite an improved understanding of the new diagnostic modalities, treatment and preventive measures, along with the new staging system established in 2009 after an extensive literature review, and an analysis of over 5,000 patients using the National Cancer Database has all been included in our article

Challenges faced by Pakistani healthcare system: Clinician\u27s perspective

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