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Case Reports
. 2018 Apr 14;6(4):669-672.
doi: 10.3889/oamjms.2018.120. eCollection 2018 Apr 15.

Treatment of a Patient with Merkel Cell Skin Carcinoma Using Radiation Therapy - A Case Report

Andrej Petrov  1   2 , Slavica Kraleva  1 , Katerina Kubelka-Sabit  1 , Deva Petrova  1
Affiliations
Case Reports

Treatment of a Patient with Merkel Cell Skin Carcinoma Using Radiation Therapy - A Case Report

Andrej Petrov et al. Open Access Maced J Med Sci. .

Abstract

Background: Merkel cell carcinoma (MCC) is a rare, very aggressive tumour. The pathogenesis remains unclear, but UV radiation, immunosuppression, and the presence of Merkel cell polyomavirus in the tumour genome appear to have a key role. Merkel cell carcinoma is a highly aggressive tumour that often has a lethal end.

Cas report: A patient at 93 years of age comes for an examination by a dermatologist due to a rapidly growing nodular tumour growth in the forehead area. A tumour was about 3 cm in size. It had no signs of basal-cell carcinoma, no arborising vascularisation, no pigmentations on dermoscopy. Clinically, an eventual Merkel cell carcinoma was considered for the patient, but other primary skin tumours had to be excluded, as well as the possibility that regarding the patient's age, it may be a metastatic deposit. A skin biopsy was performed, as well as H-E examination and immunohistochemical analyses (positive CD56, positivity of neuroendocrine markers synaptophysin, chromogranin) which were in favour of Merkel cell carcinoma of the skin. After setting the diagnosis, our patient was treated with therapy which led to a complete withdrawal of a tumour. However, after 3 months the patient had repeated relapse of a tumour at the same site on the forehead and metastases in the retroauricular lymph nodes bilaterally. It shows that the radiotherapy as monotherapy has a great effect on the removal of the tumour formation, but unfortunately, it has no impact on lesion recurrence. It is also compatible with the literature data.

Conclusion: In many adult patients, as our case suggests, radiotherapy could be a good palliative treatment opportunity that should be considered, as well as a combination of radiation therapy with other oncologic therapeutic options.

Keywords: Carcinoma; Merkel cell; Radiotherapy.

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Figures

Figure 1
Figure 1
A) Histological appearance of the tumor (hematoxilin and eosin, x200); B) Neoplastic cells show positivity for Chromogranin (x200); C) Neoplastic cells show positivity for Synaptophysin (x200); D) Neoplastic cells are negative for cytokeratins 5/6 (x200); E) Neoplastic cells are negative for cytokeratin 20 (x200); F) Ki-67 proliferative index is >90% (x200)
Figure 2
Figure 2
Patient before treatment
Figure 3
Figure 3
Patient after radiation treatment
See this image and copyright information in PMC

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