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№3' 2017

ONCOLOGY

International Medical Journal, Vol. 23., Iss. 3, 2017, P. 49−53.


MERKEL SKIN CARCINOMA:DIAGNOSIS, CLINICAL COURSE AND TREATMENT PECULIARITIES


Starykov V. I., Khodak A. S., Khodak V. P.

Kharkiv National Medical University, Kharkiv, Ukraine
S. P. Grigoriev Institute for Medical Radiology (NAMS of Ukraine), Ukraine

Merkel skin carcinoma is a rare primary malignant skin tumor with epithelial and neuroendocrine differentiation and one of the most aggressive cancers. Merkel skin cancer refers to rare diseases. The peak incidence falls on the age of 65ЃE9 years; in men the disease occurs twice as often as in women. One of the risk factors for Merkel skin carcinoma is ultraviolet irradiation. The increase in the risk of Merkel skin carcinoma development is influenced by the state of immunosuppression. Thus, Merkel skin carcinoma in AIDS patients is 2.3 times more frequent than in the unaffected population, 5 times more frequent in patients after organ transplantation. In 80 % of the samples of the examined tumors, papillomavirus was isolated. Merkel skin carcinoma is characterized by the scarcity of clinical manifestations, and often their absence. A characteristic feature is the early lymphogenous spread of the tumor cells. Rapidly growing nodules, satellites may appear near the primary neoplasia. Remote metastases are observed in 33ЃE0 % of patients. Three histological models of Merkel skin carcinoma can be distinguished: trabecular, intermediate and intercellular. Merkel skin carcinoma is characterized by high mitotic activity. Merkel skin carcinomas express antibodies −− CytokeratinAE1/AE3, Pan−Cytokeratin, Cytokeratin 20, EMA, Chromogranin, Synaptophysin, NSE. The most specific of the epithelial markers is Cytokeratin 20. If histological evidence is available in favor of Merkel skin carcinoma, immunohistochemical examination is necessary. Due to the rare incidence of carcinoma of Merkel skin carcinoma, the standards of therapy have not been developed. Surgical excision of the tumor is the basic treatment in all cases, when possible. Radiotherapy at a dose of 60ЃE6 Gy is recommended. Chemotherapy is preferable in patients with metastases. Good results were obtained using immuno−oncologic therapy (anti−PDI and anti−PD−L1). In 2015, the first data on the successful use of an anti−PD1 drug (pembolizumab) appeared. Treatment of patients with Merkel skin carcinoma should be individualized, take into account all prognostic factors and include all existing methods.

Key words: Merkel cell carcinoma, etiology, prognosis factors, treatment options.


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