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. 2009 Dec;100 Suppl 2(Suppl 2):49-54.
doi: 10.1016/s0001-7310(09)73378-2.

Toward better management of merkel cell carcinoma using a consensus staging system, new diagnostic codes and a recently discovered virus

J G Iyer  1 , S Koba, P Nghiem
Affiliations

Toward better management of merkel cell carcinoma using a consensus staging system, new diagnostic codes and a recently discovered virus

J G Iyer et al. Actas Dermosifiliogr. 2009 Dec.

Abstract
in English, Spanish

Merkel cell carcinoma (MCC) is a neuroendocrine skin cancer with a higher propensity for recurrence and metastasis than melanoma or squamous cell carcinoma. Despite aggressive behavior and the tripling of its reported incidence in the past 20 years, there is extensive confusion about how MCC should be managed. Here we address two issues that have impeded optimal MCC management: lack of a consensus staging system and lack of unique diagnostic codes for MCC. Five conflicting systems currently used to stage MCC will be replaced by one system in 2010 that will diminish confusion about prognosis and management among physicians and patients. The diagnostic bundling of MCC with numerous less aggressive skin cancers leads to care refusals by insurance and an inability to track MCC care costs. Worldwide adoption in 2009 of specific diagnostic codes for MCC will also improve understanding and management of this often-lethal skin cancer.

El carcinoma de células de Merkel (CCM) es una neoplasia cutánea neuroendocrina con una mayor propensión para desarrollar recurrencias y metástasis que el melanoma o el carcinoma epidermoide. A pesar de su comportamiento agresivo, y el hecho de que su incidencia se haya triplicado en los últimos 20 años, aún existe una gran confusión respecto al tratamiento del CCM. En esta revisión abordaremos dos cuestiones que han dificultado el tratamiento óptimo del CCM: la carencia de un sistema de estadificación consensuado y la falta de códigos diagnósticos exclusivos para el CCM. Los 5 sistemas contradictorios que actualmente se utilizan para estadificar el CCM serán reemplazados solamente por uno en 2010, lo que disminuirá la confusión sobre el pronóstico y el tratamiento entre los médicos y pacientes. La codificación diagnóstica del CCM, junto con numerosas neoplasias cutáneas menos agresivas, ha condicionado la denegación de atención por parte de las compañías aseguradoras y la incapacidad para evaluar los costes de la atención sanitaria por CCM.

La adopción, que se ha efectuado en 2009, de códigos diagnósticos específicos para el CCM también mejorará la comprensión y el tratamiento de esta neoplasia cutánea frecuentemente letal.

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Conflict of interest statement

Conflict of interest

Authors have no conflict of interest to declare.

Figures

Figure 1.
Figure 1.
Clinical Presentation of Merkel Cell Carcinoma. Examples of MCC tumors occurring in sun-exposed areas including on the middle finger (A), ear (B), eyelid (C) and upper arm (D). Prior to biopsy, MCC is commonly thought to be a cyst. Although MCC lesions often resemble a rapidly growing red/purple inflamed cyst, the lack of tenderness (88 % MCCs are non-tender), can be an important clue that such a lesion (especially in sun-exposed skin of an elderly or immune suppressed person) should not readily be dismissed as a benign cyst.
Figure 2.
Figure 2.
Merkel Cell Carcinoma is a Radiation Sensitive Cancer. A: An 87 year old woman presented with an MCC of the R ear. She refused surgical excision and underwent radiation monotherapy. B: Necrosis of the lesion 3 weeks after beginning radiation therapy. C: Complete resolution of the MCC tumor several months after completing radiation therapy. Approximately 24 months after completing radiation therapy she died of unrelated causes and had no evidence of MCC recurrence.
See this image and copyright information in PMC

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