■由于不同的复发率和不确定的随访方案,默克尔细胞癌(MCC)在监测方面面临挑战。尤其是晚期复发病例。这些案例需要超越传统时间表的个性化监控策略,如临床和分子因素,以优化患者预后。
■默克尔细胞癌(MCC)是一种罕见的,侵袭性皮肤癌伴神经内分泌分化,初始治疗后有复发倾向。MCC患者的监测策略缺乏特异性,监视的持续时间仍然不确定,在确定适当的随访间隔方面构成挑战。因此,我们介绍一位94岁的老妇人,21年前她的左鼻壁有IAMCC阶段的历史,她的左手第五个手指上有一个圆顶状的侵蚀结节。活检显示特征性MCC特征,CD56、突触素、和CK20(核周点)。患者选择不进行进一步的成像或淋巴结活检,并接受了Mohs显微手术。迄今为止,没有任何证据表明以前的部位复发或出现新的原发病灶.尽管无病间隔较长,但该病例强调了持续监测的必要性。在文献中初步诊断为MCC后,它也表现出最长的潜伏期/无复发间隔。虽然大多数复发发生在诊断后的头几年内,我们的病例突出了晚期复发的特殊性质,并提示对监测方案进行重新评估.目前的指南建议在治疗后进行长达3年的监测,但是因素,如患者的人口统计学和肿瘤特征,可能需要延长监测期。新兴的生物标志物,如默克尔细胞多瘤病毒状态和循环肿瘤DNA,在预测和监测复发方面表现出希望,但它们在晚期复发检测中的效用需要进一步调查。
UNASSIGNED: Merkel cell carcinoma (MCC) presents challenges in surveillance due to varied recurrence rates and uncertain follow-up protocols, especially in late recurrent cases. These cases need personalized monitoring strategies beyond traditional timelines, such as clinical and molecular factors, in order to optimize patient outcomes.
UNASSIGNED: Merkel cell carcinoma (MCC) is a rare, aggressive skin cancer with neuroendocrine differentiation with a propensity for recurrence following initial treatment. Surveillance strategies for MCC patients lack specificity, and the duration of surveillance remains uncertain, posing challenges in identifying appropriate follow-up intervals. Therefore, we present a 94-year-old woman, with history of stage IA MCC in her left nasal wall 21 years prior, that presented with a dome-shaped eroded nodule on her left fifth finger. Biopsy showed characteristic MCC features with positive immunohistochemistry for CD56, synaptophysin, and CK20 (perinuclear dotting). The patient opted against further imaging or lymph node biopsy and underwent Mohs micrographic surgery. To date, there has not been any evidence of recurrence at previous sites or development of new primary lesions. This case underscores the need for ongoing surveillance despite long disease-free intervals. It also stands out as the case demonstrating the longest latency/recurrence-free interval following the initial diagnosis of MCC in the literature. While most recurrences occur within the first few years post-diagnosis, our case highlights the exceptional nature of late recurrences and prompts reevaluation of surveillance protocols. Current guidelines recommend surveillance for up to 3 years post-treatment, but factors, such as patient demographics and tumor characteristics, may warrant extended monitoring periods. Emerging biomarkers, such as Merkel cell polyomavirus status and circulating tumor DNA, show promise in predicting and monitoring recurrences, but their utility in late recurrence detection requires further investigation.