Spontaneous Regression Of Merkel Cell Carcinoma
Branch, S., Maloney, K., & Purcell, S. M. (2018). Spontaneous regression of Merkel cell carcinoma. Cutis, 101(4), 301–305. https://doi.org/10.1007/978-1-4614-6608-6_14
View Original Source →Abstract
A 96-year-old woman presented with a rapidly enlarging lesion overlying the suprasternal notch. The lesion originated as a small, erythematous, scaly macule that rapidly increased in size over 8 weeks and became an ulcerated nodule measuring 5 cm in diameter and 4.5 cm in thickness. A 4-mm punch biopsy showed a poorly differentiated tumor with cells that were positive for CAM 5.2 and cytokeratin 20 in a dotlike paranuclear pattern and negative for cytokeratin 5/6, human melanoma black 45, and leukocyte common antigen. Two weeks after the punch biopsy, the lesion noticeably decreased in size, and within 8 weeks of the biopsy the tumor had completely resolved with no further intervention. Regression of Merkel cell carcinoma (MCC) is a very rare event, with as few as 30 cases reported. The mechanism of this phenomenon remains unclear; however, T-cell-mediated immunity and apoptosis appear to play a major role.
Case Details
Disease Location
Skin
Personal Characteristics
96-year-old woman
Clinical Characteristics
Presented with a rapidly enlarging lesion overlying the suprasternal notch of 8 weeks’ duration. The lesion consisted of a 5.0×4.5-cm, friable, erythematous, flesh-colored nodule with ulceration and heavy crusting. Surrounding the nodule was an erythematous to violaceous patch extending to the anterior chest and bilateral supraclavicular area. The lesion originated as a small, erythematous, scaly macule that rapidly increased in size over an 8-week period to a maximum of 5.0×4.5 cm at presentation. The lesion bled on 2 or 3 occasions during the 8-week. The lesion was treated with topical tea tree oil (for malodor) and antibiotic ointment as needed. A 4-mm punch biopsy was obtained at a follow-up visit 4 weeks later (12 weeks after the reported onset of the lesion). Showed a small-cell neoplasm with stippled nuclei and scant cytoplasm forming a nested and somewhat trabecular pattern. Mitotic activity, apoptosis, and nuclear molding were also present. A diagnosis of merkel cell carcinoma was made.
Remission Characteristics
2 weeks later, the lesion had noticeably decreased in size and lost its dome-shaped appearance. Within 8 weeks after biopsy (20 weeks since the lesion first appeared), the lesion had completely resolved
Treatment & Mechanisms
Proposed Remission Mechanisms
T-cell mediated immunity
Clinical Treatment
Antibiotic ointment biopsy
Non-Clinical Treatment
Tea tree oil