Letter to the Editor
Clinical Features of Merkel Cell Carcinoma
Características clínicas del carcinoma de células de Merkel
J. Marcoval
, J.R. Ferreres
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Servei de Dermatologia, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
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Marcoval, J.R. Ferreres" "autores" => array:2 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Marcoval" ] 1 => array:2 [ "nombre" => "J.R." "apellidos" => "Ferreres" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219017302743" "doi" => "10.1016/j.adengl.2017.04.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219017302743?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731017302703?idApp=UINPBA000044" "url" => "/00017310/0000010800000009/v1_201711021011/S0001731017302703/v1_201711021011/es/main.assets" ] ] "itemAnterior" => array:19 [ "pii" => "S1578219017302640" "issn" => "15782190" "doi" => "10.1016/j.adengl.2017.08.008" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "1705" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2017;108:884-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 496 "formatos" => array:3 [ "EPUB" => 25 "HTML" => 372 "PDF" => 99 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "Primary Mucinous Carcinoma of the Skin: A Case Report" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "884" "paginaFinal" => "886" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Carcinoma mucinoso primario cutáneo: presentación de un caso" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1005 "Ancho" => 2000 "Tamanyo" => 289602 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Skin sample after removal of the epidermis. Normal skin adnexa may be observed in the mucinous tumor (arrow). Hematoxylin and eosin (H&E), original magnification<span class="elsevierStyleHsp" style=""></span>×2. B, Detail of the tumor with lakes of mucin that contain tumor nests, with a cord-like and cribriform appearance in some areas. H&E, original magnification<span class="elsevierStyleHsp" style=""></span>×10. C, Positive staining with period acid Schiff (PAS) in the lakes of mucin. PAS, original magnification<span class="elsevierStyleHsp" style=""></span>×10. D, Diffuse, intense positivity for CK7 in the neoplastic cells. Original magnification<span class="elsevierStyleHsp" style=""></span>×10. E, Negative stain for CK20. Original magnification<span class="elsevierStyleHsp" style=""></span>×10. F, Two photomicrographs showing details of nuclear positivity for p63 in isolated cells within the tumor nests; these cells correspond to a detectable myoepithelial component in the tumor, supporting the cutaneous origin of the tumor. Original magnification<span class="elsevierStyleHsp" style=""></span>×20.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Areán-Cuns, A. Córdoba-Iturriagagoitia, B. Aguiar-Losada, I. Yanguas-Bayona" "autores" => array:4 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Areán-Cuns" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Córdoba-Iturriagagoitia" ] 2 => array:2 [ "nombre" => "B." "apellidos" => "Aguiar-Losada" ] 3 => array:2 [ "nombre" => "I." "apellidos" => "Yanguas-Bayona" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731017302739" "doi" => "10.1016/j.ad.2017.03.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731017302739?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219017302640?idApp=UINPBA000044" "url" => "/15782190/0000010800000009/v1_201711021004/S1578219017302640/v1_201711021004/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Clinical Features of Merkel Cell Carcinoma" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor:</span>" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "887" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J. Marcoval, J.R. Ferreres" "autores" => array:2 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Marcoval" "email" => array:1 [ 0 => "jmarcoval@bellvitgehospital.cat" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J.R." "apellidos" => "Ferreres" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servei de Dermatologia, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Características clínicas del carcinoma de células de Merkel" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with interest the detailed review article on Merkel cell carcinoma (MCC) published by Llombart et al.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> in March, 2017, in <span class="elsevierStyleItalic">Actas Dermo-Sifiliográficas</span>. The authors describe the clinical characteristics of this skin neoplasm as an isolated, well-defined, firm nodular tumor of erythematous, violaceous, or purpuric color. It is not adherent to deeper planes. In agreement with this description, MCC lacks specific clinical characteristics. As also discussed by Llombart et al., the acronym AEIOU (<span class="elsevierStyleItalic">A</span>symptomatic, <span class="elsevierStyleItalic">E</span>xpanding rapidly, <span class="elsevierStyleItalic">I</span>mmunosuppression, <span class="elsevierStyleItalic">O</span>lder than 50, and <span class="elsevierStyleItalic">U</span>V exposure) has recently been defined.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> However, the diagnostic suspicion of MCC is top of the list of differential diagnoses in only 1% of all cases.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> The most important distinctive characteristic highlighted by various authors is that it tends to be a rapidly growing, asymptomatic tumor (63% of patients in a survey reported rapid growth of their tumors within 3 months).<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> As few studies have focused on the clinical characteristics of MCC, we decided to analyze the characteristics of our series of patients with MCC. We observed 2 distinct clinical patterns depending on whether the tumors were in sun-exposed areas or non-exposed areas.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a> In our experience, tumors in sun-exposed areas of skin typically present as tumors with superficial erosions and a tendency to bleed, whereas those in non-sun-exposed areas tend to present as nodular lesions, frequently lobulated, with a smooth, shiny surface with no erosions. All showed rapid growth. Sun-exposed lesions tended to be of less than 2<span class="elsevierStyleHsp" style=""></span>cm in diameter (perhaps because they were more easily detected by the patient) and were more common in older men, whereas non-sun-exposed tumors are larger and tended to affect younger patients. Sun-exposed lesions were difficult to distinguish from more common skin tumors, such as squamous cell carcinoma. However, most non-sun-exposed tumors presented as nodular lesions with a smooth and shiny surface with no erosions, and many were lobulated. In our experience, this clinical appearance in a rapidly growing tumor is relatively specific and should suggest a clinical diagnosis of MCC before performing biopsy.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Marcoval J, Ferreres J. Características clínicas del carcinoma de células de Merkel. Actas Dermosifiliogr. 2017;108:887.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Update on Merkel cell carcinoma: epidemiology, etiopathogenesis, clinical features, diagnosis, and staging" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B. Llombart" 1 => "C. Requena" 2 => "J. Cruz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2016.07.022" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2017" "volumen" => "108" "paginaInicial" => "108" "paginaFinal" => "119" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27770997" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0025" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical characteristics of Merkel cell carcinoma at diagnosis in 195 patients: The AEIOU features" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Heath" 1 => "N. Jaimes" 2 => "B. Lemos" 3 => "A. Mostaghimi" 4 => "L.C. Wang" 5 => "P.F. Peñas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2007.11.020" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2008" "volumen" => "58" "paginaInicial" => "375" "paginaFinal" => "381" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18280333" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0030" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Merkel cell carcinoma: differences between sun-exposed and non-sun-exposed variants--a clinical analysis of 36 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Marcoval" 1 => "J.R. Ferreres" 2 => "R.M. Penín" 3 => "D. Pérez" 4 => "J.M. Viñals" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000363104" "Revista" => array:6 [ "tituloSerie" => "Dermatology" "fecha" => "2014" "volumen" => "229" "paginaInicial" => "205" "paginaFinal" => "209" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25278300" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010800000009/v1_201711021004/S1578219017302743/v1_201711021004/en/main.assets" "Apartado" => array:4 [ "identificador" => "6202" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010800000009/v1_201711021004/S1578219017302743/v1_201711021004/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219017302743?idApp=UINPBA000044" ]
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