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Combined SCC/Merkel cell carcinoma arises on elderly adults with history of NMSC

Combined squamous cell carcinoma and Merkel cell carcinoma was aggressive and arose on ultraviolet-damaged skin of elderly Caucasian patients with a history of nonmelanoma skin cancer, according to recently published study results.

Researchers compared data for 26 patients with combined squamous cell carcinoma/Merkel cell carcinoma (SCC/MCC) and 20 patients with Merkel cell carcinoma (MCC). They also reviewed clinical and dermoscopic images from nine patients with SCC/MCC.

Patients with SCC/MCC were older than MCC patients at diagnosis, with a median age of 76.5 years vs. 69 years. Twenty-three patients with SCC/MCC were Caucasian. The patients with SCC/MCC also were more often male (77% vs. 60%), had a greater incidence of nonmelanoma skin cancer (85% vs. 25%; NMSC), lymphoprolific disorders (23% vs. 10%), malignant extracutaneous tumors (25% vs. 5%) and immunodeficient/pro-inflammatory states (77% vs. 35%) when compared with the patients with MCC only.

Higher metastatic rate (77%) — with metastases typically occurring in the head and neck areas — was reported for patients with SCC/MCC, compared with the MCC cohort (40%). The patients with MCC experienced metastases in both the head and neck area and trunk.

Treatment failures (53% vs. 45%), shorter survival (41 months vs. 54 months) and more disease-related mortality (50% vs. 40%) also was experienced by the patients with SCC/MCC.

In the dermoscopic review of nine patients with SCC/MCC, marked scale (7 of 9) and telangiectasia (1 of 9) were evident. Small dotted vessels and short linear irregular vessels at the periphery were seen in reviewing high-quality dermoscopic images.

“Dermoscopically, polymorphous vessels in lesions suspicious for [NMSC] are suggestive,” the researchers concluded. “Given that the MCC component frequently exists within the dermis, and not in the epidermis, biopsies inclusive of the dermis should be performed when evaluating potential NMSC, so as not to miss an underlying deadly neuroendocrine component with a too superficial shave, causing delays in diagnosis and treatment of this aggressive and often fatal tumor.” – by Bruce Thiel

Disclosure: Suárez reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.