Merkel's cell carcinoma in organ recipients - Report of 41 cases

In the general population Merkel's cell carcinoma (MCC) is an aggressive ne uroendocrine skin cancer. More than 600 cases have been reported. MCC seems to be common in transplant recipients, with 41 cases being reported to the Cincinnati Transplant Tumor Registry, and another 11 in the transplant lit erature. In the general population, it is a disease of older adults, with o nly 5% of cases occurring below the age of 50 years. In transplant patients , the mean age at diagnosis was 53 (range 33-78) years, and 29% of recipien ts were <50 years old. The tumor appeared from 5 to 286 (mean 91.5) months after the transplant. Of 44 lesions that occurred in 41 patients, the distr ibution was similar to that seen in the general population, with 36% occurr ing on the head and neck, 32% on the upper extremities, 16% on the trunk, 9 % at unknown sites, and 7% on the lower extremities. Twenty of the patients (49%) had 22 other malignancies, the great majority of which (91%) were ot her skin cancers. Treatment depended on the stage of the disease and includ ed wide surgical excision, radical lymph node dissection, radiation therapy , and chemotherapy. In transplant patients, MCC probably proved to be more aggressive than in the general population in that 68% of patients developed lymph node metastases and 56% died of their malignancies. Furthermore, one third of surviving patients still have active cancers from which they may die. Also, follow-up of survivors has been relatively short, with a mean of only 18 (range 0-135) months.