2026 NCCN Guidelines for Merkel cell carcinoma
October 30, 2025
The National Comprehensive Cancer Network (NCCN) is a group of approximately the top 30 cancer centers in the U.S. that collaborate to publish yearly treatment guidelines for specific cancer types. These guidelines help doctors understand how to best treat their patients. The 2026 NCCN guidelines for Merkel cell carcinoma (MCC) include important changes from the 2025 guidelines based on the latest research. Key changes that are relevant to most patients include:
- Some blood tests, such as viral antibody tests and circulating tumor DNA (ctDNA), can help monitor for any return of MCC over time. If the original diagnosis was made using only a small core biopsy, doctors may try to collect additional tumor before starting immunotherapy or radiation. Having more tumor available can allow for special tests, like ctDNA testing, that can guide treatment decisions later.
- There are also updated treatment guidelines for a newer type of radiation therapy called hypo-fractionated radiation therapy. This method gives higher doses of radiation in fewer visits, so the overall number of treatments is lower and the treatment course is shorter.
- Because several treatment options now exist, it’s important for MCC patients to be cared for by a team that includes many different specialists, such as dermatologists, medical oncologists, radiation oncologists, and surgeons. In advanced Merkel cell carcinoma, immunotherapy drugs such as avelumab, pembrolizumab, nivolumab, or retifanlimab are commonly used. For patients whose cancer does not respond to these treatments, a combination of ipilimumab and nivolumab may be considered. These treatments can also be combined with surgery or radiation to improve results.
These updates give doctors more tools to treat MCC effectively and help patients get better, up-to-date care.
Read the 2026 NCCN Guidelines here: Merkel Cell Carcinoma Clinical Resources