Open AccessMerkel cell carcinoma and the challenge in its approach: a review based on a clinical context of immunosuppression
Author(s) -
Filipe Coutinho,
Miguel Horta,
E. M. S. da Rocha,
Carlos Vasconcelos,
António Araújo
Publication year - 2018
Publication title -
porto biomedical journal/porto biomedical journal
Language(s) - English
Resource type - Journals
eISSN - 2444-8672
pISSN - 2444-8664
DOI - 10.1016/j.pbj.0000000000000011
Subject(s) - merkel cell carcinoma , immunosuppression , medicine , stage (stratigraphy) , context (archaeology) , merkel cell polyomavirus , oncology , disease , lymph node , carcinoma , dermatology , paleontology , biology
Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine cancer with high rate to local relapse and metastasis. Its connection to immunosuppression is well known, with reported association to human immunodeficiency virus (HIV). The authors present an 87-year-old woman, infected by HIV type 2 at advanced stage of the disease, whom presented a painless papule on left cheek in 2011. After its total excision, the histopathology confirmed MCC “in situ,” with no regional or distant metastases. Simultaneously, she revealed a viral load of 2220 copies/mL and 224 CD4/mm 3 . Five months later, the patient presented a local and distance relapse with an aggressive behavior and positive regional lymph node. Stage IV disease was confirmed due to presence of liver metastases. Concurrently to the relapse, it was detected low CD4 levels. In our multidisciplinary team decision meeting, it has been decided conservative treatment due to low Karnofsky status, comorbidities, and stage of disease.