Background: Merkel Cell Carcinoma (MCC) is an aggressive neuroendocrine skin cancer. Though rare, in recent decades its prevalence has increased, and its incidence has tripled.
Objectives: To describe a cohort of MCC patients treated at a referral center in northern Israel, and to compare their characteristics and course of illness to cases reported in the literature.
Methods: A retrospective review of 18 MCC patients treated in the Plastic Surgery Department at the Rambam Health Care Campus between the years 2011-2016. Patient demographics, medical history, histological findings, systemic involvement, adjuvant therapy, recurrence and survival rates parameters were collected and analyzed.
Results: Study group patients were predominantly elderly, mostly men, and mainly Caucasian. A few were immunocompromised. Melanoma and MCC are known to be linked, and indeed, about a quarter of the patients suffered previously from melanoma. Diabetes, although not described as an MCC risk factor, has accounted for about 50% of cases, more than 5 times its prevalence in the general population. Tumor and metastases distribution were similar to the literature. Metastases were found in about 20% of cases at diagnosis. In one third of the patients, lymph nodes were already involved during surgery, with recurrence rates of 50%, and 40% mortality in five years.
Conclusions: Study results, for the first time, imply that there might be an association between diabetes and MCC. A link that could explain the rise of MCC incidence in recent decades. In addition, treatment guidelines were defined for metastatic disease which include the novel immunotherapy as a central component in treatment; hopefully, to improve patients' prognosis in this life-threatening disease.