Merkel cell carcinoma is more deadly than melanoma

This was in the Sydney Morning Herald today:

Rare skin cancer touted as most lethal

Belinda Tasker, AAP National Medical Correspondent

July 8, 2011 – 1:04PM

AAP

Move over melanoma, a little known form of skin cancer has taken the dubious title of being the most deadly form of the disease.

Scientists in Western Australia discovered that survival rates for people with merkel cell carcinoma (MCC) were far worse than those for melanoma, which has been widely regarded as the most lethal skin cancer.

They also found that WA had the highest rates of MCC in the world, with 215 cases diagnosed between 1993 and 2007.

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Of those cases, just 64 per cent of patients were still alive after five years compared to 90 per cent of those with melanoma.

Lead researcher Professor Lin Fritschi, of the WA Institute for Medical Research, said while MCC was an aggressive form of skin cancer it was still relatively uncommon.

“We don’t want everyone worried because we had 215 cases in 13 years,” she told AAP.

“There’s 1000 melanomas a year in WA so it’s nowhere near as common as melanoma.

“But it’s not well diagnosed and it’s quite aggressive and it has a high mortality compared to other skin cancers.”

MCCs take the form of pink lumps on the skin – compared to melanomas which are blackish in colour – and are most often found on the face, neck, arm and lower leg.

Like melanomas, MCCs are believed to be caused by sun exposure.

Those most likely to develop MCCs are older men, people with a history of skin cancer and those with suppressed immune systems due to liver and kidney transplants.

Prof Fritschi said that MCCs were often mistaken for the less aggressive and most common form of skin cancer, basel cell carcinomas (BCCs).

However, even when they were correctly diagnosed, removed and the patient treated with radiotherapy, the tumours were still prone to reappear.

“I don’t think doctors would see them often compared to BCCs and SCCs (squamous cell carcinoma, which are non-melanoma skin cancers),” Prof Fritschi said.

“Most red lumps on your skin are not going to be MCC but it’s something for doctors to keep aware of.”

The study by Prof Fritschi and her research colleagues has been accepted for publication in the British Journal of Dermatology.

They based their findings on a review of the WA Cancer Registry and now plan to expand their study to look at MCC rates across Australia.

The team said MCCs were not widely studied despite Australia having the highest rates of sun-related cancers in the world.

“Given the potential link between sun exposure and MCC incidence, it might be predicted that MCC rates in Australia would be high,” they wrote.

The researchers said there was some evidence that MCC rates leapt in the 1980s before stabilising in the late 1990s.

But they were not sure if the reported increases were real or the result of improved diagnosis.

They also added that while there was some suggestion of a link between MCCs and a newly-discovered viral infection, sun exposure was probably a greater risk factor in Australia.

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  1. #1 by Lester Cowell on July 8, 2011 - 12:27 pm

    Melanoma are not just black. Melanoma can have up to 6 colors – light & dark brown, grey, black, blue . Some estimates have up to 15% of melanoma being light colored with just a small amount of brown or tan in a pink background. Indeed some melanoma are just flat shiny pink patches. Some can be even more difficult for while most melanoma are brown to black with irregular edges and display asymmetric features and over 5mm diameter (ABCD) some melanoma are firm round symmetric pink lumps . Merkel Cell cancers typically present as a rapidly growing firm smooth pink lump.

    Dr Lester Cowell
    Skin Cancer Practitioner Hamilton Hill WA

  2. #2 by Hein Vandenbergh on July 12, 2011 - 10:47 am

    Agree entirely, Lester – but that’s the daily press for you. Better than nowt – or NotW [News of the World].

    Saw a lady today, about 50, PH of NMSC, FH [father – RIP] MM. Took over her father’s farm after his death from cerebral secondaries, lot of time outdoors. Skin type I, II at a pinch. Attuned to risks. Travels 250 km each way twice a year for skin checks, reluctant to rely on my advice but won her over.

    Rapidly growing [weeks], shiny, pink, sl irreg firm lump on wrist [in the ‘anatomical snuffbox’]. Very atypical vessels on polarised d’oscopy [N-P too much compression]. My d/diagnoses are poorly difftd SCC, AMM, or MCC. The latter HAS to be considered, although relative wrong gender/age, rest fits. Will KYP.

    Tell the folks I’m well, but no real email access during the day: work in 3 different practices full-bore, occas time for a fart, that’s all – will consolidate end Sept. Great work and environs, though. Should have done this YEARS ago…….

    PS – ever eaten a cheese semmitch driving a bouncy 4WD ute at 150 kph between a.m. and p.m. clinics? I won’t do it again, either, Ossifer, promise…. Should disconnect the turbo one day. Not that the local dry-cleaners minded.

  3. #3 by k mason on October 18, 2011 - 7:35 am

    wow! doctor’s with humour – where can I find you?? (Dr Lester, are you taking any more patients!?). LUV the story of the cheese semmitch!
    seriously, tho, it’s fantastic to see your light-hearted corrections to Belinda’s article in the Syd M Herald. are our WA journalists better able to present the true picture- because we have such a large slice of the world’s cases of MCC?
    [why am I looking in here – seeing as I’m an ‘ordinary’ citizen? coz one of my BFs has just last week been diagnosed with an MCC on her lower leg 😦 cancer touches my life in many ways]
    k

  4. #4 by Lester Cowell on October 18, 2011 - 10:27 am

    Hi,
    The Cheese semmitch was from Hein in NSW not me in Hamilton Hill WA.

    As usual press has over sold the story . Absolute Incidence of Merkle Cell Cancer death is very very low. Intercourse is more fatal for older men in absolute terms than a Merkles. The worry is that the incidence of this fearsome beast is increasing . Affects older persons .

    This is not a new disease – nearly 20 years ago the word “Merkle Cell ” was mentioned in hushed silence lokk “you know who” of Harry Potter fame – he who can not be named !

    The fearsomeness of MCC versus MM is embedded in the case fatality rate. With Melanoma in most countries it is about 1 death for 8 diagnoses – 8 cases : 1 death . The median thickness of melanoam in Australia is 0.86 mm. The five year survival of thin melanoma , those less than 1.0 mm is 98% in WA. With MCC , 50% of lesions lead to death in 2 years and all lesion s over 2 cm are fatal. In grows back with terrifying rampant pace. MM might be bad , but the MCC is demonic .

    LC

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