Dr. Scot Ackerman Joins WJXT to Discuss Jimmy Buffet’s Passing from Merkel Cell Carcinoma

Dr. Scot Ackerman recently joined the WJXT team to discuss Jimmy Buffet’s passing due to Merkel Cell Carcinoma. He was diagnosed with Merkel Cell Carcinoma four years prior to his passing.

Although skin cancer is the most common type of cancer in the United States, Merkel Cell Carcinoma is uncommon. About 2000 cases of MCC are diagnosed in the US each year. This disease begins when Merkel cells start to grow out of control. It quickly grows and can be difficult to treat due to late diagnoses. Merkel Cell Carcinoma often originates on skin that is exposed to the sun (face, neck, & arms), but can show up anywhere on the body. Due to increased life spans and weakened immune systems, the number of diagnoses has been rising over the past few years.

Risk Factors:

• Age: 4 out of 5 people diagnosed with Merkel Cell Carcinoma are older than 70
• Gender: Men are twice as likely to be diagnosed as women
• Race: White/Caucasian people are much more likely to be diagnosed than other races- 9 out of 10 diagnoses are in White/Caucasian people
• Merkel Cell Polyomavirus Infection: MCC Polyomavirus Infection is a common virus that is found in the cancer cells of 8 out of 10 diagnoses. This infection was first discovered in 2008 and as it does not cause symptoms, it rarely leads to MCC. Therefore, there are not currently any recommended screening tests or treatments
• UV Exposure:  from the sun, tanning beds, psoriasis treatments
• Weak Immune Systems: People who have received organ transplants, have been diagnosed with HIV, or have certain types of blood cancers are more likely to develop MCC than others

Signs and Symptoms:

• MCC first appears as a single pink, red or purple shiny bump that doesn’t cause pain- these bumps can sometimes bleed
• MCC can spread to lymph nodes, which appear as lumps underneath the skin and are usually in the neck or arm
• MCC is often not found until the tumor is large and is biopsied, at which point the cancer has already spread to other parts of the body

Diagnostic Tests:

• Physician Exam: A physical exam performed by your physician is often the first step in testing for MCC. Your physician will note the size, shape, color, and texture of the suspected area
  • If your physician suspects that you may have MCC, they will refer you to a specialist (dermatologist), who will most likely perform a dermatoscopy
• Skin Biopsy: If your physician believes the area is suspicious, a skin biopsy will be performed. This Skin Biopsy can be a shave, punch, or incisional biopsy. Another commonly performed biopsy is a Lymph Node Biopsy, which can be a sentinel, needle, or excisional biopsy
• Imaging Tests: Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and Positron Emission Tomography (PET)

Treatment Options: Your treatment will be determined based on a variety of factors, including the extent of the cancer, location of tumor, and your age and overall health.

• Surgery: Often performed by your specialist/dermatologist- surgery can entail MOHS, wide excision, lymph node dissection, and skin grafting
• Radiation therapy: Radiation Therapy can be utilized in multiple ways
  • Post-surgery to treat area of main tumor
  • Main treatment option to treat the tumor
  • Treat lymph nodes near the main tumor
  • Treat recurrent MCC
  • Treat metastatic MCC to shrink/slow the growth of the cancer or ease symptoms
• Chemotherapy: Most helpful when used to treat metastatic MCC
• Immunotherapy: Most helpful when also used to treat metastatic MCC

Survivorship: The 5 year survival rate for Merkel Cell Carcinoma is 70%. It is important to schedule follow ups with your care team every 3-6 months for the first 3 years, and then every 6-12 months after. Your care team can also provide you with a survivorship care plan that keeps you on track and assists you with living your healthiest life.