Merkel cell carcinoma treatment

Seattle Cancer Care Alliance (SCCA) has one of the most active Merkel cell carcinoma (MCC) clinical and research programs in the world, led by Paul Nghiem, MD, a dermatologist and scientist at the forefront of MCC care. Our experts offer comprehensive MCC treatment at the Multidisciplinary Skin Oncology Clinic, including advanced therapies and new options available only through clinical studies.

A diagnosis of cancer can feel overwhelming. We have an experienced, compassionate team ready to help. 

Merkel cell carcinoma expertise at SCCA

Everything you need is here

We have dermatologists, surgeons, medical oncologists, radiation oncologists and nurses who specialize in MCC; the most advanced diagnostic, treatment and recovery programs; and extensive support. 

Innovative Merkel cell carcinoma therapies

SCCA patients have access to advanced therapies being explored in clinical studies for MCC conducted here and at our founding organizations Fred Hutchinson Cancer Research Center and UW Medicine.

MCC treatment tailored to you

We view treatment as a collaborative effort. Your SCCA doctors will explain all your options and recommend a treatment plan based on the location, size and stage of your cancer and your overall health.

Team-based approach

Your personal team includes more than your MCC doctors and nurses. Additional experts who specialize in treating people with cancer will be involved if you need them — experts like a palliative care professional, social worker, physical therapist or dietitian.

Ongoing care and support

During and after treatment, your team continues to provide follow-up care on a schedule tailored to you. The SCCA Survivorship Clinic is also here to help you live your healthiest life as an MCC survivor.

Treatment for early Merkel cell carcinoma

Surgery and radiation therapy are the most common treatments for people with early-stage MCC (stage I or II, when the main tumor has not spread to lymph nodes or other parts of the body).

Surgery

If you have early-stage disease, you will likely have surgery to remove the tumor. Often surgeons perform a procedure called wide surgical excision, taking out the cancer and some of the skin around it.

Depending on the size and location of your tumor, your team may recommend a method called Mohs micrographic surgery. This method helps maintain your function and appearance in sensitive areas, like your face. The surgeon removes one thin layer of tissue at a time. During surgery each layer is examined under a microscope to determine whether the surgeon needs to remove another layer in order to get all of the tumor.

Although surgery can be effective, the rate of local recurrence (cancer coming back in the same place) is very high in people who have surgery alone. When the removed tissue is examined under a microscope, the margins may be free of cancer, suggesting the surgeon got it all. But because of the way MCC spreads, cancer cells are often left behind in neighboring tissue.

Learn more about surgical oncology.

Radiation therapy

To kill remaining cancer cells, surgery is often followed by external-beam radiation therapy to the tumor site and possibly to the lymph nodes in the same region of the body. MCC is very sensitive to radiation therapy.

There is evidence that in some people radiation alone may be a viable treatment option. This option makes the most sense for people who would need extensive surgery or those who cannot have surgery for medical reasons.

Learn more about radiation oncology.

Treatment for advanced Merkel cell carcinoma

Treatment for advanced disease may involve surgery, radiation therapy and also systemic therapy, which treats cancer throughout your body

Surgery and radiation therapy

If you have more advanced MCC that has spread to nearby lymph nodes but not to other parts of your body (stage III), you are likely to have surgery to remove the cancer followed by radiation to the main site as well as the regional lymph nodes.

Learn more about surgical oncology and radiation oncology.

Immunotherapy

If your cancer has spread to distant parts of your body (stage IV), you are likely to need systemic therapy. Until recently, the standard systemic option was chemotherapy, which would shrink many tumors but provide only about three months of cancer control. Many recent clinical trials have led to a major shift toward treatments designed to stimulate your own immune system to fight your disease. 

The most promising emerging option for MCC is a class of drugs called immune checkpoint inhibitors (ICIs).

In March 2017, the U.S. Food and Drug Administration approved the first treatment for metastatic MCC: the ICI avelumab (Bavencio). SCCA was one of the leading sites for a clinical trial testing this medicine. 

In the study, avelumab was used to treat 88 patients who had metastatic MCC that had come back despite at least one round of chemotherapy. Twenty-eight of those patients’ tumors shrank or disappeared in response to avelumab. Among patients who initially responded to the medicine, over 80% had responses lasting more than a year.

Many patients not only did well, without evidence of active cancer, but also had very good quality of life while receiving this therapy.

Another ICI, pembrolizumab (Keytruda), has also shown promise. The National Comprehensive Cancer Network (NCCN), which publishes treatment guidelines based on expert opinion, added pembrolizumab to its list of MCC treatment options in 2017 after research showed it shrunk many patients’ tumors and provided long-lasting results. NCCN has also listed the ICIs avelumab and nivolumab (Opdivo) as preferred treatments over chemotherpay for metastatic MCC.

Other ICIs, including ipilimumab (Yervoy), are being studied in clinical trials for people with advanced MCC. In addition, several other immunotherapy approaches are being investigated, including intra-tumoral injections and infusion of immune cells (T-cells or Natural Killer cells). Initial results suggest a promising future for immunotherapies in treating MCC.

Learn more about immunotherapy.

Chemotherapy

In general, chemotherapy is reserved for late stages of MCC, when immune therapies are not an option. For people who do not have problems with their immune system (no autoimmune disease and no major immunosuppressive medications), doctors typically recommend first trying an immune-stimulating therapy (such as an immune checkpoint inhibitor) before using chemotherapy.

Learn more about chemotherapy.

Minimizing immunosuppression

People whose immune system isn’t functioning at a normal level are at increased risk for MCC. For instance, those whose immune systems are suppressed — because of human immunodeficiency virus (HIV), a solid organ transplant or chronic lymphocytic leukemia or another cancer — are 10 to 20 times more likely to get MCC, and their disease is more likely to recur.

Reducing immunosuppression can be part of the therapy for MCC. If there’s any way to decrease your immunosuppression, this may help your body control the cancer.

Clinical studies for Merkel cell carcinoma

For some people, taking part in a clinical study may be the best treatment choice. Access to clinical studies by researchers at SCCA and our founding organizations Fred Hutch and UW Medicine is one reason many patients come to SCCA. 

Find open clinical trials for Merkel cell carcinoma at SCCA, and visit our Patient Guide to Clinical Trials to learn about participating.

Learn more

We have created an extensive resource of educational materials at www.merkelcell.org, where you can learn more about the disease.

Next steps