Baseline Imaging

Purpose of baseline imaging

Baseline imaging is an important part of the initial staging of Merkel cell carcinoma Merkel cell carcinoma A skin cancer composed of cells that look microscopically similar to normal Merkel cells present in the skin. MCC was first described in 1972 and only in the 1990s was the CK20 antibody developed to make it easily identifiable by pathologists. Many doctors and patients are not aware of this cancer because of its recent description and relative rarity (~2,000 cases/year in the US--roughly 30 times less common than melanoma). About 40% of patients treated for MCC will experience a recurrence, making it far more aggressive than most other types of skin cancer, including melanoma. . Imaging studies can reveal nodal or distant disease that cannot be detected by physical examination. It is recommended that patients undergo PET/CT as a part of their initial work-up as it is more sensitive than CT alone.

Who this works for

Patients who have been diagnosed with Merkel cell Merkel cell Merkel cells are found in the lower part of the epidermis. Although the exact function of Merkel cells is unknown, they are thought to be touch receptors. Also known as neuroendocrine cells, they have machinery similar to nerve cells and to hormone-secreting (endocrine) cells. carcinoma carcinoma Cancer that originates in the skin or in the tissues lining the gut and ducts. and are in the staging process. It is recommended that patients undergo a sentinel lymph node biopsy sentinel lymph node biopsy Removal and examination of the "sentinel" lymph node(s). Sentinel nodes are the first lymph nodes to which cancer cells spread from a primary lesion. To identify the sentinel lymph node(s), a radioactive substance and/or dye is injected near the primary lesion. The surgeon uses a Geiger counter to find the lymph node(s) containing the radioactive substance or looks for the lymph node(s) stained by the dye. The surgeon then removes the sentinel lymph node(s) and sends them to a pathologist to check for the presence of cancer. to assess the disease status of the draining lymph nodes near their primary tumor. However, even if this biopsy biopsy The removal of cells or tissue in order to determine the presence, characteristics, or extent of a disease by a pathologist usually using microscopic analysis. is negative, it is still recommended that patients undergo a baseline PET/CT as studies have shown that for patients who were negative for regional nodal disease, 13.2% were found to have disease elsewhere by imaging studies.

Who this doesn’t work for

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Often used in conjunction with

Sentinel lymph node lymph node A rounded mass of lymphatic tissue that is usually surrounded by connective tissue and about the size of a green pea. Lymph nodes filter lymphatic fluid, also know as lymph, which is fluid that drains from the tissues of the body and contains immune cells. Cancer cells often travel through lymph vessels and lodge and grow in lymph nodes, sometimes causing the nodes to markedly increase in size. biopsy and serology testing. For patients who do not produce oncoprotein antibodies, imaging studies are an important part of disease surveillance.

What to do next

For patients who are found to have nodal or distant disease, it is recommended that imaging studies be conducted periodically to assess the response of disease to treatment. It is recommended that patients undergo serology testing as a part of their initial work-up. For patients that do produce oncoprotein antibodies, they can choose to continue getting this test and a rise in oncoprotein antibodies would indicate a need to undergo imaging studies to assess disease status. For patients who do not produce onocoprotein antibodies, it is recommended that they undergo imaging studies every 6 months as a part of recurrence surveillance.