From the Guidelines
Merkel cell carcinoma in the finger is a rare but aggressive type of skin cancer that requires prompt medical attention, and the standard approach typically involves surgical removal of the tumor with wide margins, followed by sentinel lymph node biopsy and radiation therapy to reduce the risk of recurrence, as recommended by the NCCN clinical practice guidelines in oncology 1. The tumor typically appears as a painless, firm, red or purple nodule on the finger and grows rapidly. Early detection and treatment are crucial because this cancer can spread quickly to lymph nodes and other organs, significantly affecting prognosis. Some key points to consider in the management of Merkel cell carcinoma include:
- Surgical excision with 1- to 2-cm margins to the investing fascial layer remains the standard surgical technique, as outlined in the NCCN guidelines 1
- Mohs surgery, modified Mohs surgery, or complete circumferential peripheral and deep-margin assessment (CCPDMA) may be considered if tissue sparing is critical
- Radiation therapy is often recommended after surgery to reduce the risk of recurrence
- For advanced cases, immunotherapy medications like pembrolizumab (Keytruda) or avelumab (Bavencio) may be prescribed, typically administered intravenously every 2-3 weeks
- Regular follow-up appointments are essential, usually every 3-6 months for the first two years, then annually, as Merkel cell carcinoma has a high recurrence rate. The five-year survival rate is much higher when caught early before it has spread beyond the skin, highlighting the importance of prompt medical attention and treatment, as noted in the NCCN guidelines 1.
From the FDA Drug Label
(1.15) Merkel Cell Carcinoma (MCC) for the treatment of adult and pediatric patients with recurrent locally advanced or metastatic Merkel cell carcinoma. The Merkel Cell Carcinoma (MCC) treatment with pembrolizumab is indicated for adult and pediatric patients with recurrent locally advanced or metastatic disease 2.
- Key points:
- Treatment indication: Recurrent locally advanced or metastatic Merkel cell carcinoma
- Patient population: Adult and pediatric patients
- Note: The term "Merckel tumor" is likely a misspelling of Merkel Cell Carcinoma.
From the Research
Merkel Cell Carcinoma Overview
- Merkel cell carcinoma (MCC) is a rare neuroendocrine tumor of the skin associated with a high risk of local recurrence and distant metastases 3.
- It most commonly occurs on sun-exposed areas of white patients >65 years of age 3.
- The Merkel cell polyomavirus (MCV) is thought to be responsible for malignant transformation in approximately 80% of cases in the northern hemisphere, while ultraviolet radiation-induced DNA damage is implicated in MCV-negative tumors 3.
Treatment Options
- Excision of the tumor is the first-line therapy; if not feasible, radiotherapy can often effectively control the disease 4.
- Mohs micrographic surgery (MMS) as monotherapy may offer an alternative treatment modality, with no local recurrences due to inadequate excision and a 5-year Kaplan-Meier MCC-specific survival rate of 91.2% for AJCC8 Stage I and 68.6% for AJCC8 Stage II 5.
- Immune checkpoint inhibitors, such as avelumab and pembrolizumab, are first-line agents for metastatic MCC 6.
Prognosis and Survival
- The 2-year and 5-year overall and disease-specific survival rates for patients with MCC are 64.8% and 38.8% versus 45.2% and 26.4%, respectively 7.
- Patients diagnosed initially with an open biopsy have significant worse overall and disease-free survival rates compared with patients who had a wide local excision 7.
- Monitoring for recurrence can be aided by Merkel cell polyomavirus oncoprotein antibody titers 6.
Specific Location - Finger
- There is no specific information available on Merkel cell carcinoma occurring in the finger, as the provided studies do not mention this location explicitly.
- However, MCC can occur on any sun-exposed area of the skin, and the finger is a possible location, although it may be less common than other areas such as the head and neck 3, 4.