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Treatments and drugs
By Mayo Clinic staffThe type of treatment you'll receive depends on whether the cancer has spread beyond your skin by the time it's diagnosed. You might have just one type of treatment or a combination of treatments:
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Surgery. During surgery, your doctor removes the tumor along with a border of normal skin surrounding the tumor. Removing a border of normal skin helps catch any remaining cancer cells. If there's evidence that the cancer has spread to lymph nodes in the area of the skin tumor, those lymph nodes are removed (lymph node dissection).
Occasionally, your doctor may use a procedure called Mohs micrographic surgery. After removing the visible tumor, your doctor creates "slices" of the tumor tissue and examines each slice under a microscope. The process is repeated until cancer cells are no longer visible in the tissue slice. This type of surgery takes out less normal tissue — thereby reducing scarring — but ensures a tumor-free border of skin. Mohs surgery is often used to remove skin cancer from the face.
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Radiation therapy. Radiation therapy involves directing high-energy X-rays at cancer cells. Radiation damages the genetic material in growing cells. Cancer cells are particularly susceptible to the effects of radiation because they divide more rapidly than normal cells do.
In cases of Merkel cell carcinoma, radiation therapy is usually given to kill any cancer cells that remain after the tumor is removed. Because this type of cancer is so rare, there's no established consensus about who should receive radiation after surgery completely removes a tumor. Talk with your doctor about the pros and cons of radiation after surgery in your particular situation.
Radiation may be used to shrink Merkel cell carcinoma before it's removed or as the sole treatment in people who choose not to undergo surgery. Radiation can also be used to treat areas of metastases that are causing symptoms.
General side effects from radiation therapy include red, irritated skin, fatigue and hair loss if the scalp needs to be radiated. If you receive radiation therapy to your head or neck, you may notice that you have a dry mouth, difficulty swallowing and other symptoms.
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Chemotherapy. Chemotherapy uses drugs to kill the cancer cells or stop them from dividing. Depending on the type of drug, chemotherapy may be injected, swallowed or applied to your skin.
Chemotherapy is generally used when Merkel cell carcinoma has spread to other organs in your body or when it has recurred. However, whether chemotherapy improves the survival rate in people with Merkel cell carcinoma is unclear. Talk with your doctor about the benefits and risks of using chemotherapy in your case.
Chemotherapy often causes significant side effects, most of which are temporary. Common side effects include nausea, vomiting and diarrhea; hair loss; fatigue and an increased risk of infection. Rarely, permanent damage to your body organs may occur.
During the course of treatment, you'll undergo physical exams, including blood tests, to monitor how you're responding to radiation therapy or chemotherapy. Afterward, you'll continue having frequent checkups with your doctor to watch for recurrences.
The outlook after treatment for Merkel cell carcinoma varies, depending on a number of factors. These include the stage of the tumor at diagnosis, your age, the tumor size and location, and whether you have other health conditions. Generally, otherwise healthy people with small tumors and no evidence of cancer spreading beyond the skin tend to have the best prognoses.
