Merkel Cell Carcinoma

If you have a spot on your skin suspicious for MCC, or suspicious for any skin cancer, your dermatologist will likely perform a biopsy. Skin biopsies are a common, quick and safe procedure, and nothing to be anxious about. During a biopsy, the spot is first cleansed, then numbed with local anesthetic. A small specimen is removed and sent to a lab to be studied by a dermatopathologist. If MCC is diagnosed, the primary approach is to remove the cancer surgically. This may be done at your usual dermatology clinic. Sometimes lymph nodes need to be checked as well, to look for metastasis; in that case, you may be referred to a surgical oncologist. Sometimes there may also be a need for adjuvant chemotherapy, immunotherapy or radiation therapy, in which case you may be referred to a medical oncologist as well.

 

In any case, for MCC, as for all skin cancers, early detection is key. It is recommended to get a routine annual full-body skin exam with a dermatology provider. These exams are non-invasive, take only minutes, and can truly be life-saving. OnSpot has made these exams more convenient than ever, bringing mobile dermatology clinics to people’s neighborhoods and places of work, even seeing walk-ins. Skin cancers can be quite subtle, apparent only to a trained eye. Frequently patients come to the clinic concerned about multiple spots which are in fact harmless, but during their exam, one or more cancers are found which the patient was not aware of. This is because, often times, the spots which look bad are in fact benign, while the cancerous spots don’t look like much, unless one knows what to look for.

 

And while MCC is quite rare, skin cancer in general is not. Skin cancer is by far the most common of all cancers, with one out of five Americans developing skin cancer by age 70. Basal cell carcinoma, the most common form of skin cancer, is 1,800 times more common than Merkel cell, and squamous cell carcinoma, the second most common form, is 900 times more common. Melanoma is more rare than these, with an overall lifetime risk of 2.6% for white people, 0.1% for black people, and 0.6% for hispanic people, but it is more dangerous. All of these cancers, however, are highly treatable if caught early, and that is what your dermatology provider is trained to do during an annual skin exam.

 

Aside from getting an annual full-body skin exam, the most important thing you can do on your own to prevent getting a skin cancer is to protect yourself from damaging ultraviolet (UV) rays. Never use a tanning bed, and make sunscreen part of your normal daily morning routine. We are often asked what type of sunscreen is best. The short answer is that tinted mineral sunscreen is best, but anything is better than nothing.

 

When it comes to sunscreen, there are two main types: chemical and mineral. Chemical sunscreens contain ingredients such as oxybenzone, avobenzone, octisalate, homosalate, octocrylene and octinoxate, which are absorbed into the skin, where they convert UV rays into heat, thus protecting the skin. But they are also absorbed into the blood, and there is some controversy regarding their safety. The heat dispersed can also worsen certain skin conditions. Mineral sunscreens, on the other hand, contain ingredients such as zinc oxide, titanium oxide, and iron oxide, which form a protective barrier on the skin’s surface which physically blocks the sun’s rays. They can be applied on top of other medicines or cosmetics, and they work immediately on application, without having to wait 20-30 minutes as with chemical sunscreens. Years ago, mineral sunscreens were associated with a thick, white color which made them obviously visible, but these days, the ingredients are micronized to be less visible, and can be formulated with more of a subtle beige color (tinted). There are even spray-on mineral sunscreens now available. Look for SPF 30 or higher, and remember to re-apply every few hours. An even better physical protection than mineral sunscreen is clothing, brimmed hats and sunglasses. And even better than protective clothing is shade. If possible, try to avoid being in the sun when its UV rays strike us most directly and strongly, between 10 am and 4 pm.

 

Finally, there are steps you can take not only to reduce your risk of skin and other cancers, but to increase your overall health and well-being. The body’s first line of defense against enemies both foreign (such as infection) and innate (such as cancer) is the immune system. Many cancers have ways of fooling the immune system to protect themselves, but you can reduce your overall risk and boost your immune system by living a healthy lifestyle. Get proper sleep and practice good sleep hygiene, don’t smoke, don’t drink too much alcohol, eat a healthy, balanced diet and take a daily multivitamin, exercise for at least 30 minutes 3-5 times per week, and try to avoid excessive stress and anxiety.

 

Jimmy Buffett’s music evokes an island, coastal vibe which many of us hold dear. Writing from Florida’s Gulf Coast, I know most of our permanent and seasonal residents cherish the Sunshine State for that very reason, having many fond memories involving beaches, piers, boats, pool decks and backyard barbecues, walking, cycling, and generally enjoying our state’s bright, warm outdoors. Following these simple steps can help us to do so while keeping ourselves and our loved ones healthy and safe.