Prognosis of Merkel cell carcinoma patients with autoimmune disorders, other types of immune dysfunction, or immunocompetent status: Analysis of 762 patients

February 15, 2024


Journal of American Academy of Dermatology

Publication Date

February 15, 2024


Park S, Hippe D, Zawacki L, Bierma M, Bhatia S, Nghiem P, Zaba L, Singh N Summary

Autoimmune diseases happen when the body’s immune system mistakenly attacks its own cells. Common examples include arthritis and inflammatory bowel disease (IBD). People with these conditions may have an immune system that does not work properly because of their disease or the medications they take for it. Autoimmune disease patients make up about 20% of MCC patients with weakened immune systems. Research including 762 MCC patients found that patients with autoimmune diseases have a medium level risk of MCC recurrence compared to patients with normal or other immune-weakening conditions, like chronic lymphocytic leukemia (CLL). This shows the need for careful treatment planning for MCC patients with autoimmune diseases and the importance of further research to develop the best treatment strategies for such patients.


 Merkel cell carcinoma (MCC) is an aggressive skin cancer with a high risk of recurrence,1 particularly in immunosuppressed individuals. Patients with autoimmune disease (AD) constitute around 20% of the immunosuppressed MCC patients, where immunosuppression arises from both immune dysregulation and iatrogenic factors.2,3 However, it is unclear whether AD is associated with poor outcomes in MCC.

We analyzed data from a Seattle-based repository of 762 MCC patients (enrolled 2003-2021). Patients were categorized into the following: AD-related immunosuppression (n = 31), other immunosuppressed conditions (n = 69), and immunocompetent individuals (n = 662; Supplementary Fig 1, available via Mendeley at Immunosuppressive medication changes by patients with AD were collected. In addition, MCC recurrence and MCC-specific mortality were compared between the groups using Fine and Gray regression, treating other deaths as competing risks.

Clinical characteristics of the eligible patients are shown in Supplementary Table I (available via Mendeley at, with types of ADs diagnosed shown in Supplementary Table II (available via Mendeley at and the other types of immunosuppression in Supplementary Table III (available via Mendeley at Two-year recurrence risks were 31%, 37%, and 67% for the immunocompetent, AD, and other immunosuppression groups, respectively (Fig 1A). Two-year risks were >60% for each of the subgroups of patients in the “other” immunosuppression subtype (Supplementary Fig 2, available via Mendeley at Patients with other immunosuppressive conditions had a significantly higher recurrence rate than immunocompetent patients after adjusting for age, sex, and stage (adjusted hazard ratio [aHR]: 2.61, 95% CI, 1.85-3.68, P < .001). Patients with AD had a statistically nonsignificant increased risk of recurrence compared with immunocompetent patients (aHR: 1.53, 95% CI, 0.78-3.01, P = .22) and decreased risk compared with other, non-AD immunosuppressed patients (aHR: 0.59, 95% CI, 0.28-1.23, P = .16; Supplementary Table IV, available via Mendeley at

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