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Merkel Cell Carcinoma in the HIV-1/AIDS Patient

  • Robert H. Goldstein
  • James A. DeCaprio
Chapter
Part of the Cancer Treatment and Research book series (CTAR, volume 177)

Abstract

Merkel cell carcinoma (MCC) is a highly aggressive, primary neuroendocrine cancer of the skin. The majority of MCC cases are associated with the recently discovered Merkel cell polyomavirus (MCPyV), while the remaining are caused by ultraviolet (UV) light-induced mutations from excessive sunlight exposure. The risk of developing MCC is much higher in the white population relative to all other races. Approximately 10% of all patients with MCC have some form of immunosuppression including HIV-1/AIDS, chronic inflammatory conditions, solid organ transplantation, or hematological malignancies. The age of onset of MCC is lower and the mortality is higher in immunosuppressed individuals than in immune-competent patients. It is plausible that HIV-1/AIDS predisposes to virus-positive MCC, but it should be noted that HIV-1/AIDS increases the risk for developing of UV-induced skin cancers such as cutaneous squamous cell carcinoma and basal cell carcinoma and therefore may also increase the risk for virus-negative MCC. Surgical management is considered standard of care for localized Merkel cell carcinoma with current recommendations advising a wide local excision of the lesion. Most international guidelines support the use of local adjuvant radiotherapy coupled with tumor staging to improve the frequency of cure. For advanced, metastatic, and recurrent MCC, checkpoint blockade inhibitors targeting PD-1 and PD-L1 have shown remarkable activity including durable long-term. MCC in patients living with HIV-1/AIDS are treated with similar modalities as HIV-1 uninfected individuals with MCC.

Notes

Acknowledgements

This work was supported in part by U.S. Public Health Service grants R01CA63113, R01CA173023, and P01CA050661 and the DFCI Helen Pappas Merkel Cell Research Fund and the Claudia Adams Barr Program in Cancer Research to J.A.D.

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Division of Infectious Disease, Department of MedicineMassachusetts General Hospital and Harvard Medical SchoolBostonUSA
  2. 2.Department of Medical OncologyDana-Farber Cancer InstituteBostonUSA
  3. 3.Department of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonUSA

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