MERKEL CELL CARCINOMA
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ALTERNATE NAMES
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Merkel Cell Cancer; Trabecular Cancer; Apudoma of Skin; Small Cell Neuroepithelial
Tumor of Skin; Primary Small Cell Carcinoma of Skin; Toker Tumor; Primary Cutaneous
Neuroendocrine Tumor; Malignant Trichodiscoma; Neuroendocrine Carcinoma of the Skin
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DESCRIPTION
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Merkel Cell Carcinoma (MCC) is a rare, aggressive skin cancer that forms in the outer layer of the skin (epidermis).
MCC often appears in areas of the skin exposed to the sun, such as the head and neck,
arms, legs, and trunk. However, MCC may also develop anywhere on the body, even on
areas not exposed to sunlight. MCC with
Metastases occurs when the tumor spreads to other parts of the body. MCC that has metastasized
has a significantly higher mortality than malignant melanoma of the skin.
The incidence of MCC is somewhat greater for males. It is most common in people older
than age 50, although it can occur at any age.
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DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND
ICD-9-CM/ICD-10-CM
CODING
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Diagnostic testing: Diagnosis is made with a sentinel lymph node biopsy and immunohistochemical stains.
Blood tests, such as liver function tests, may be used to detect the spread of MCC
to internal organs. MCC is difficult to diagnose through imaging studies in its early
stages.
Physical findings: The first sign of MCC is usually a fast-growing, painless nodule (tumor) on the skin.
The shiny nodule may be skin colored or may appear in shades of red, blue or purple
that initially may be mistaken as a benign cyst. Most MCCs appear on the face, head
or neck, but they can develop anywhere on the body, even on areas not exposed to sunlight.
Physical exam may reveal the following findings:
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An enlarged lymph node; and
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ICD-9: 209.31 – 209.36, 209.75
ICD-10: C4A
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PROGRESSION
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MCC metastasizes quickly and spreads to other parts of the body, tending towards the
regional lymph nodes. The tumor tends to invade underlying subcutaneous fat, fascia,
and muscle. MCC has an extremely poor prognosis after it has spread to distant sites,
especially the organs (such as, liver, lung, bone, or brain). For people with positive
lymph nodes, median survival is 13 months compared to 40 months in those people with
negative nodes.
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TREATMENT
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Treatment for MCC is based on the stage and location of the lesion, and whether the
tumor has spread to the lymph nodes or other parts of the body. Treatment may consist
of: 1) surgical excision of the primary lesion, 2) lymph node surgery, 3) radiation
therapy, and 4) chemotherapy. Chemotherapy is usually reserved for late stage MCC,
and mostly as a palliative therapy.
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SUGGESTED PROGRAMMATIC ASSESSMENT*
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Suggested MER for Evaluation:
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A biopsy confirming the diagnosis of MCC.
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Suggested Listings for Evaluation:
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DETERMINATION
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LISTING
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REMARKS
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Meets
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13.03 A
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MCC with metastases to or beyond the regional lymph nodes meets the criteria in listing
13.03 A.
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13.03 B
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MCC that invades deep extradermal structures meets the criteria in listing 13.03B. |
113.03
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Equals
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* Adjudicators may, at their discretion, use the Medical Evidence of Record or the
listings suggested to evaluate the claim. However, the decision to allow or deny the
claim rests with the adjudicator.
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