• Archives of Reconstructive Microsurgery
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• v.18 no.1
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• pp.31-34
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• 2009

Purpose: Merkel cell carcinoma, also called neuroendocrine carcinoma, is a very rare type of skin cancer that develops as Merkel cells grow out of control. Merkel cell carcinoma is reported below 1% of whole skin neoplasms in the United States and is known that the 2-year survival rate is about 50~70%. The principles of treatment are wide excision of primary lesion with radiotherapy and/or chemotherapy that decrease the local recurrent rate. There has been no report of reconstruction with free flap after resection of Merkel cell carcinoma in Korea. Methods: We reconstructed the skin and soft tissue defect after wide excision of Merkel cell carcinoma with anterolateral thigh perforator free flap in two cases. No distant metastasis was found at the preoperative imaging work-up. In one case, preoperative chemotherapy was performed and the size of lesion was decreased. Results: There were no recurrence and significant complications. Functionally and aesthetically satisfactory results were obtained with reconstruction. Conclusion: Wide excision and reconstruction with anterolateral thigh perforator free flap for Merkel cell carcinoma patient is the first report in Korea. We regard this method as the treatment of choice in Merkel cell carcinoma.

• The Korean Journal of Cytopathology
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• v.16 no.2
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• pp.93-97
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• 2005

Merkel cell carcinoma (MCC) is a rare primary cutaneous neuroendocrine carcinoma which commonly presents as a skin nodule, and can develop into regional lymph node metastases, as well as spread systematically. Here, we describe the cytological features of a touch imprint of MCC that arose on the face of a 62-year-old female. This touch imprint was acquired from an incisional biopsy specimen which had been submitted for frozen section. The touch preparation produced a highly cellular imprint of loosely cohesive groups of small- to medium-sized malignant cells exhibiting uniform round to oval nuclei, delicate nuclear membranes, fine chromatin, small nucleoli, and scanty cytoplasm, with occasional paranuclear button-like inclusions. We applied cytokeratin 20 to the touch imprint for immunochemistry, allowing us to visualize the tumor cells with paranuclear dot-like positivity. Both the cytological and immunocytological features were quite distinct.

• Radiation Oncology Journal
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• v.36 no.2
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• pp.163-170
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• 2018

Merkel cell carcinoma (MCC) is a rare neuroendocrine tumor of the skin initially believed to arise from the Merkel cells. In the community setting a general radiation oncologist may only encounter this pathology in a handful of cases over the course of their career. Due to the low incidence of this malignancy, few prospective randomized controlled trials have ever been conducted and therefore guidelines are based on relatively lower levels of evidence upon which the clinical recommendations are made. We discuss the case of a female in her 90s presenting with a classic MCC primary lesion, as well as satellite lesions proximal to both the primary and the draining regional lymph nodes with no evidence of nodal involvement. Here we discuss the presentation, management, treatment planning, underlying pathology, results and sequelae of treatment. We also review new treatment modalities, and the most current staging systems and guidelines.

• The Korean Journal of Cytopathology
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• v.17 no.2
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• pp.143-147
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• 2006

Merkel cell carcinoma (MCC), a rare primary cutaneous small cell neuroendocrine carcinoma, is a tumor with distinct cytological features. In many cases, immunohistochemical staining (IHC) is required for the differentiation from other small round cell malignancies. Here we describe the cytological findings of Merkel cell carcinoma; these findings contributed to the diagnosis prior to performing IHC. A lower eyelid mass was excised and submitted for frozen section diagnosis. The frozen section diagnosis was consistent with a malignancy, but the more specific diagnosis was limited by the lack of specific histological features. Touch imprint cytology revealed a high cellularity with loosely cohesive small to large sized cells. The tumor cells showed hyperchromatic nuclei with fine chromatin and inconspicuous nucleoli, and thin-rimmed-cytoplasm including the characteristic eosinophilic button-like paranuclear inclusion, previously described as a pathognomonic cytological finding of MCC; this was not found in the H&E frozen section. In conclusion, we suggest that the touch imprint cytology may help in the differential diagnosis of small round cell neoplasms prior to performing IHC especially in frozen section diagnosis.

• Archives of Plastic Surgery
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• v.33 no.2
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• pp.233-236
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• 2006

Merkel cell carcinoma is rare skin malignancy originated from epidermal mechanoreceptor of neural origin. The tumor usually affects older individuals at sun exposed area such as head, neck and extremity. Subclinical involvement of regional lymph node is reported frequently at the time of initial treatment. Thus even asymptomatic patients who present with clinically localized tumor should undergo evaluation with computed tomography and lymphangiography. Positron emission tomography(PET) scans can imaging the metabolic difference of malignant tumors. Increased glucose uptake of malignant tumor cells are detected by PET scanner. PET scans can provide qualitative and quantitative informations about systemic metastasis of tumors. Although there are no data that define the efficacy of PET scans in the initial diagnostic evaluation of head and neck cancer, they could be considered. Current standards of treatment of Merkel cell carcinoma is wide surgical excision and regional lymphadenectomy if there are suspicious lymph nodes. The author reported a patient with Merkel cell carcinoma of cheek. Wide surgical excision and postoperative PET/CT was done for evaluation of regional lymph node and distant metastasis. There were two hot-uptakes in patient's neck, so they were considered as metastatic node, but finally they were proved to be tuberculosis lymphadenitis after excision.

• Archives of Craniofacial Surgery
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• v.20 no.3
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• pp.203-206
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• 2019

Merkel cell carcinoma (MCC) is a rare and highly aggressive neuroectodermal carcinoma arising from mechanoreceptor Merkel cells. Multiple MCCs are even rarer. We report a case of two independent MCCs simultaneously present in the cheek of a patient, which were effectively and esthetically treated using a cheek flap. Punch biopsy performed in a 60-year-old woman admitted with a chief complaint of two skin-colored hard nodules in her left cheek, accompanied by an itching sensation, was suggestive of MCC. Accordingly, we performed sentinel lymph node biopsy through the modified Blair incision under general anesthesia, in cooperation with the head and neck surgery department. The defect was covered with a cheek flap by slightly extending the existing incision following wide excision with a safety margin of 1 cm. This paper is significant in that it introduces an effective reconstruction technique that maintains function using a cheek flap for the management of this rare case. In addition, this paper is the first to classify multiple MCCs according to the time of onset. We believe that this paper presents an effective alternative reconstruction technique with sentinel node biopsy through the modified Blair incision.

• Archives of Craniofacial Surgery
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• v.20 no.6
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• pp.401-404
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• 2019

Merkel cell carcinoma (MCC) is a relatively rare and aggressive cutaneous neuroendocrine malignancy. It is characterized by high rates of recurrence and metastasis, both to regional lymph nodes and to distant locations. Its characteristic clinical manifestation is a single, painless, hard, erythematous nodule on a sun-exposed area, particularly in older men. Surgical management of both the primary site and the sentinel lymph node is the standard of care. In this article, we describe the diagnosis and treatment of a case of MCC in the left cheek.

• Applied Microscopy
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• v.26 no.1
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• pp.79-93
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• 1996

The differentiation of nail matrix and fine structure of matrix cells were studied with light and electron microscope using specimens from nails of thumb finger in Korean fetuses 14 to 24 weeks old. Fetal nail matrix consisted of two horizontal layers, thicker ventral and thinner dorsal matrices, originating from invagination of epidermis in proximal nail field. Matrix being generally thicker in its distal region than the apex became gradually thickened with increase of the fetal age. Each matrix consisted of single layer of basal cells and multiple layers of squamous cells which are arranged close to and parallel to the central axis of the nail mairix. The process of keratinization of fetal nail matrix was noted to be occured concurrently in the ventral and dorsal matrices along the central axis of matrix toward distal and dorsal direction. Squamous cells became matured with accumulation of tonofilaments, increase of keratohyalin granules, discharge of membrane coating granules, and narrowing of intercellular spaces, thickening of plasma membrane and finally being transformed into horny cells of nail plate. Horny cells of nail plate filled with fibrous elements in the electron dense amorphous substance. These findings of keratinization process of fetal nail matrix appeared to be similar to those of keratinization in epidermis and inner root sheath of the hair. In the nail matrix, however, corresponding region to the keratogenous zone of growing hair follicle was not observed. Vacuolated squamous cells of nail matrix seen on light microscopy was considered to be artefactual product, but squamous cells with condensed small nuclei rarely found adjacent nail plate was considered to be one of the squamous cells with unknown function. Proximal end of nail plate was observed on dorsal surface of nail field distal to the proximal nail fold at 14 and 16 weeks old human embryos. Proximal prolongation of the proximal end of nail plate was occured with advancing fetal age and afterward 21 weeks nail plate invaded into nail matrix. Melanin granule containing cells and Merkel cells were present only on the basal layer of dorsal nail matirx.

• The Journal of Korean Physical Therapy
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• v.5 no.1
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• pp.79-87
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• 1993

The purpose of this literature review was to identify the physiological changes with aging. The results of this renew were to follows : We have seen a wide variety of such changes in the cells and in all organ systems. 1. At least 40 percent of people over 65 will die of cardiac disease, 15 percent of cerebrovascular disease, and possibly another 5 percent of other types of vascular impairment. 2. The increase rigidity of the thoracic wall and the decreased strength of the expiratory muscles decrease the propulsive effectiveness of the cough. 3. The density of capillaries per motor units is decreased. 4. Starting before age 40 in both sexes there is a shift from an increase in bone mass to a progressive decrease. 5. Histologic studies show a lim age-correlated decrease in the number of Pacini's. Merkel's, and Meissner's corpuscles.

• Applied Microscopy
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• v.24 no.2
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• pp.63-77
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• 1994

This experiment was performed to study the morphological responses of the epidermis of the rat scalp, following X-ray irradiation. Male rats were divided into normal and experimental groups. Rats anesthetized with sodium thiopental, were exposed only on their head areas with a single dose of 3,000rads or 6,000rads, respectively. Radiation was produced by Mitsubishi Linea Accelerator ML-4MV at the speed of 200rads/min. The target distance was 80cm. Animals were sacrificed on six hours, two days and six days following irradiation. By the perfusion fixation through the heart, rats were fixed with 1% glutaraldehyde-1% paraformaldehyde solution. Pieces of the tissue taken from the scalp were refixed in 2.5% glutaraldehyde-1.5% paraformaldehyde solution, followed by post-fixation with 1% osmium tetroxide, and embedded within araldite mixture. The sections were cut on a LKB-V ultratome, stained with uranyl acetate and lead citrate, and were observed with JEM 100CX-II electron microscope. The results were as follow; 1. Six hours after exposure to 3,000rads of X-ray. Disrupted intercellular spaces, within which some amorphous materials were filled, disrupted mitochondria, and vacuoles in the keratinocytes were frequently observed, but six days after exposure to 3,000rads of X-ray, Morphology of the keratinocytes was generally restored. 2. Many of the morphological changes were seen on the six days after exposure to 6,000rads of X-ray. 3. Widened intercellular spaces and thickened dense plaques of the desmosomes were frequently observed after exposure to 6,000rads of X-ray. 4. In the experimental groups, the Langerhans and the Merkel cells were damaged, similarly to the keratinocyte. Above results suggest that head irradiation with the dose of 3,000rads temporarily damaged the epidermis of the scalp, though most of the structures recover within six days, whereas with the dose of 6,000rads it severely damaged the epidermis without showing any recovering tendency.