Rates of Aggressive Skin Cancer Increasing Rapidly

An aggressive form of skin cancer, Merkel cell carcinoma (MCC), is increasing rapidly in the U.S. population. Research from the University of Washington in Seattle, led by Song Youn Park, MD, found that this cancer increased 95% in the last 10 years. By comparison, during 2000-2013, the number of reported solid tumor cases rose 15% and melanoma cases rose 57%.1,2

Rare but often fatal

Dr. Park presented her findings at the American Academy of Dermatology (AAD) 2018 Annual Meeting in Feb. 2018.1

The study recorded roughly 2,800 cases in the U.S. in 2010, up from about 1,500 cases in 2007. Compared to melanoma with its tens of thousands of new cases each year, MCC is still rare and often fatal due to lack of awareness among doctors and the public.

Dr. Park estimates the number of new MCC cases will rise to 2,835 cases a year in 2020 and 3,284 in 2025, with 75% of that increase due to the aging Baby Boomer population and 25% due to population growth.1,2

Often a late diagnosis

Merkel cell carcinoma is a rare form of skin cancer, most often diagnosed in older people. In fact, the average age of diagnosis is 65, and unlike melanoma, the incidence of MCC continues after age 85. However, MCC can also occur among people ages 40-64.3

Dr. Park and her team also estimate that Merkel cell carcinoma has a mortality rate of roughly 40% versus 8% for melanoma. The higher mortality rate is partially due to MCC's aggressive nature and partially to late diagnosis, said Dr. Park.

Sounding the alarm for early diagnosis

As with other forms of cancer, better outcomes require early diagnosis. However, Merkel cell carcinoma's rarity means that even experienced dermatologists may have never seen a case. Increasing the level of difficulty in getting an accurate and early diagnosis, Merkel cell carcinoma may present in a variety of ways.

An MCC tumor usually appears as a firm lump that is painless and grows quickly. It may be red, purple or skin-colored, unlike melanoma which usually looks like a dark mole.3 MCC most often appears where the skin has received the most sun, or ultraviolet light exposure: on the face, shoulders and upper arms. It's more common in fair skinned people and slightly more common among men.

Risk factors for Merkel cell carcinoma

  • Infection with the Merkel cell polymavirus
  • Weakened immune system (eg, after organ transplantation, chronic blood cancer, HIV infection, or aging)
  • Psoriasis treatment with psoralen and ultraviolet A (PUVA)
  • History of another cancer1,2

Approximately 20% of cases appear to be the direct result of exposure to sun, or ultraviolet light, rather than the virus, Dr. Park said.1

Hope on the horizon

There is a glimmer of good news amongst the gloom. Awareness of MCC is growing, so early identification is increasing, too. At stage 1, MCC is usually treated with surgery followed by radiation. For more advanced cases, the new FDA-approved immunotherapy drug Bavencio® (avelumab) has been approved by the FDA.1-3

With more cases identified and identified early, doctors expect survival rates to improve, said Darrell Rigel, MD, of New York University in New York City.1

To protect yourself from MCC, it's important to reduce the amount of sun you are exposed to over time. Dermatologists recommend people seek shade when possible, wear protective clothing and use a broad-spectrum, water-resistant sunscreen of SPF 30 or higher.

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