Ludzkie koronawirusy - autor: Krzysztof Pyrć z Zakładu Mikrobiologii, Wydział Biochemii, Biofizyki i Biotechnologii, Uniwersytet Jagielloński, Kraków

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© Borgis - New Medicine 3/2015, s. 87-89 | DOI: 10.5604/14270994.1179833
*Konrad Wroński1, Zbigniew Masłowski2, Przemysław Stefaniak2, Leszek Frąckowiak3
Treatment Merkel cell carcinoma of the facial skin – case report
1Department of Oncology, Faculty of Medicine, University of Warmia and Mazury, Olsztyn, Poland
Head of Department: prof. Sergiusz Nawrocki, MD, PhD
2Department of Surgical Oncology, Hospital Ministry of Internal Affairs with Warmia and Mazury Oncology Centre, Olsztyn, Poland
Head of Department: Andrzej Lachowski, MD
3Department of Public Health and Epidemiology, University of Warmia and Mazury, Olsztyn, Poland
Head of Department: prof. Anna Abramczyk, MD, PhD
Summary
Merkel cell carcinoma (MCC) is a rare neuroendocrine malignancy of the skin. It is highly aggressive skin cancer which is observed in patients older than 50 years (more than 95%). Merkel cell carcinoma was first time described by Toker in 1972. Merkel cell carcinoma often presents a rapid growth, reddish-blue dermal papule and can be asymptomatic. Surgery and radiotherapy are the most important in treatment Merkel cell carcinoma. Up to 48% of Merkel cell carcinomas are located in the head and neck region. Recommendations for surgery are based on the clinical size of the primary tumor. Excision margins for tumors < 2 cm should be 1 cm, and for tumors > 2 cm the margins should be 2 cm. Sentinel lymph node biopsy is recommended for all untreated primary tumors at the time of wide local excision. SLN biopsy is important in the staging and prognosis of Merkel cell carcinoma. In this article the authors presented a case of a 60-year-old man, Caucasian race, who was admitted to the hospital because of Merkel cell carcinoma of the facial skin. The patient underwent wide excision of the tumor and in the sixth day after surgery was discharged home.
INTRODUCTION
Merkel cell carcinoma (MCC) is a rare neuroendocrine malignancy of the skin (1, 2). It is highly aggressive skin cancer which is observed in patients older than 50 years (more than 95%) (1, 3). The cell of origin was first time described in 1875 by Friedrich Merkel as epithelial in derivation with neuroendocrine differentiation (3). Merkel cell carcinoma was first time described by Toker in 1972 (3). Merkel cell carcinoma often presents a rapid growth, reddish-blue dermal papule and can be asymptomatic. Surgery and radiotherapy are the most important in treatment Merkel cell carcinoma (1, 2).
CASE REPORT
A 60-year-old man, Caucasian race, was admitted to the Department of Surgical Oncology because of Merkel cell carcinoma of the facial skin (fig. 1 and 2). In an interview with the patient, he informed us that the tumor of the facial skin was observed six months earlier and gradually expanded. The patient reported pain in the area of the tumor. Surgical biopsy showed Merkel cell carcinoma.
Fig. 1. Merkel cell carcinoma of the facial skin.
Fig. 2. Bleeding Merkel cell carcinoma of the facial skin.
He had no any other symptoms, there was no history of weight loss and loss of appetite. The patient was not treated chronically diseases. He had no surgeries before and there was no history of carcinoma in patient family. Blood test and other routine hematological examinations and biochemical tests were within normal limits.
On physical examination, there was bleeding tumor size 55 x 65 millimeters. Regional lymph nodes were not enlarged. The patient was qualified for surgery. In general anesthesia has been wide tumor resection of the right temporal area with adequate free margins and free graft skin was taken from the supraclavicular region. The tumor was collected for histopathological examination. Histopathological examination revealed Merkel cell carcinoma. The tumor was excised in its entirety. The duration of surgery was 65 minutes. Patient after surgery felt good and did not complain of pain. The postoperative period was uncomplicated and the patient left the ward in the sixth day after surgery. The patient is in the care of outpatient surgical oncology.
DISCUSSION

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Piśmiennictwo
1. Lemos B, Nghiem P: Merkel cell carcinoma: more deaths but still no pathway to blame. J Investig Dermatol 2007; 127: 2100-2103. 2. Lemos BD, Storer BR, Iyer JG et al.: Pathologic nodal evaluation improves prognostic accuracy in merkel cell carcinoma: analysis of 5823 cases as the basis of the first consensus staging system. J Am Acad Dermatol 2010; 63: 751-761. 3. Toker C: Trabecular carcinoma of the skin. Arch Dermatol 1972; 105: 107-110. 4. Agelli M, Clegg LX: Epidemiology of primary Merkel cell carcinoma in the United States. J Am Acad Dermatol 2003; 49: 832-841. 5. Miller RW, Rabkin CS: Merkel cell carcinoma and melanoma: etiology similarities and differences. Cancer Epidemiol Biomarkers Prev 1999; 8: 485. 6. Feng H, Shuda M, Chang Y et al.: Clonal integration of a polyomavirus in human Merkel cell carcinoma. Science 2008; 319: 1096-1100. 7. Shuda M, Feng H, Kwun HJ et al.: T antigen mutations are a human tumor-specific signature for Merkel cell polyomavirus. Proc Natl Acad Sci USA 2008; 105: 16272-16277. 8. Heath M, Jaimes N, Lemos B et al.: Clinical characteristics of merkel cell carcinoma at diagnosis in 195 patients: The AEIOU features. J Am Acad Dermatol 2008; 58: 375-381. 9. Kivela T, Tarkkanen A: The Merkel cell and associated neoplasms in the eyelids and periocular region. Surv Ophthalmol 1990; 35: 171-187. 10. Mortier L, Mirabel X, Fournier C et al.: Radiotherapy alone for primary Merkel cell carcinoma. Arch Dermatol 2003; 139: 1587-1590. 11. Veness M, Foote M, Gebski V et al.: The role of radiotherapy alone in patients with Merkel cell carcinoma: Reporting the Australian experience of 43 patients. Int J Radiat Oncol Biol Phys 2010; 78: 703-709. 12. Garneski KM, Nghiem P: Merkel cell carcinoma adjuvant therapy: current data support radiation but not chemotherapy. J Am Acad Dermatol 2007; 57: 166-169.
otrzymano: 2015-06-29
zaakceptowano do druku: 2015-07-17

Adres do korespondencji:
*Konrad Wroński
General Surgery Consultant
Department of Surgical Oncology Faculty of Medicine University of Warmia and Mazury
al. Wojska Polskiego 37, 10-228 Olsztyn, Poland
tel.: +48 505-818-126
e-mail: konradwronski@wp.pl

New Medicine 3/2015
Strona internetowa czasopisma New Medicine