Dermatological manifestations of the neuroendocrine cancer: a four cases report of primitive and metastatic Merkerl cell tumor
Francesco Buda, Roberto Colle, Oreste Bergamo, Gordana Svenda & Concetta Buda
Merkel cell cancer, is a very rare, malignant, neuroendocrine tumour. of the skin The cause is not known. Is and often aggressive malignancy with high tendency for local recurrence, lymph node involvement and distant metastasis and a poor prognosis and rapid progression. The Merkel cell is located in or near the basal layer of the epidermis and is closely associated with terminal axons. The aims in this study we report four cases of Merkel cell tumor of the skin(1 primary and 3 metastatic).The primary carcinoma occurred as multiple dermal nodules on the right arm showing a fast growth and spreading to regional lymph nodes.In the metastatic cases the primary tumor was often ulcerated and local regional metastatis were massive.The main diagnostic role of electron microscopic studies of the primary lesion and the importance of the immunohistochemistry are validated. Superficial lesions were easily detected by fine needle aspiration biopsy and histological examination of surgical excisions.The Surgical of primary tumor were followed by a high incidence of local recurrence and distal metastasis(3 /4 pts);median DSF was 10 months.A correct surgical treatment of primary lesions,independent of site, may influence the rate of local regional invasion.For this reason a close follow-up is advisable, including the seric control of NSE levels because of the good correlation of this enzyme to disease outcone.Since the role oh the complementary therapies has not been completelyestablished, adjuvant therapy may be reserved for high risk pts(young aged,with high L.I.,with lymphatic and /or haematic involvement.As standardized protocols in Merkel cell tumour are lacking, AA. Suggest that the primary treatment consider a wide surgical excision of the primary lesion and regional lymph nodes followed bay local regional radiotherapy. Metastatic cases are treatated with chemotherapeutic regimens used for oat cell carcinoma of the lung because of the close morphobiological similarity exsting between these two tumors.