Helpful Resources / Clinician Resources

Clinician Resources

The following documents and references are recommended for clinicians with recently diagnosed MCC patients.


  • NCCN Clinical Practice Guidelines in Oncology for Merkel Cell Carcinoma
    The NCCN Guidelines® are a statement of evidence and consensus of the authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult the NCCN Guidelines is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient’s care or treatment. The National Comprehensive Cancer Network® (NCCN®) makes no representations or warranties of any kind regarding their content, use or application and disclaims any responsibility for their application or use in any way. The NCCN Guidelines are copyrighted by National Comprehensive Cancer Network®. All rights reserved. The NCCN Guidelines and the illustrations herein may not be reproduced in any form without the express written permission of NCCN.


For a complete list of MCC-related publications from Dr. Nghiem’s lab please click here. Additional clinical publications related to Merkel cell carcinoma can be found on our News & Publications page.

Overviews of MCC for clinicians

Imaging/Surveillance of MCC

Resources for Newly Diagnosed patients

Clinical Trials for MCC


General Information

  1. Agelli M, Clegg LX. Epidemiology of primary Merkel cell carcinoma in the United States. Journal of the American Academy of Dermatology 2003; 49:832-41.
    National Cancer Institute epidemiologic study of 1,034 patients with MCC that found 1) a higher incidence of MCC in whites, males and patients older than 65 years, 2) that roughly half of all cases were localized, 3) better survival was associated with limb localization, early stage disease, younger age and female sex. This study does not contain data on what treatments patients received.
  2. Bichakjian CK, Lowe L, Lao CD, Sandler HM, Bradford CR, Johnson TM, Wong SL. Merkel cell carcinoma: Critical review with guidelines for multidisciplinary management. Cancer 2007; 110:1-12.
    Comprehensive reference for MCC treatment based on critical evaluation of the current available data.
  3. Goessling W, McKee PH, Mayer RJ. Merkel cell carcinoma. Journal of Clinical Oncology 2002; 20:588-598.
    Comprehensive review of MCC based on the oncology literature.
  4. Nghiem P, Jaimes N. Chapter 120: Merkel cell carcinoma. In Wolff K, Katz S, Goldsmith L, Gilchrest B, Leffell D, Paller A (eds), Fitzpatrick’s Dermatology in General Medicine; 7th Edition. New York, NY: McGraw-Hill, 2007.
    Chapter thoroughly explaining what is currently known about MCC.
  5. Nghiem P, McKee PH, Haynes HA. Merkel cell (cutaneous neuroendocrine) carcinoma. In Sober AJ, Haluska FG (eds): American Cancer Society Atlas of Clinical Oncology: Skin Cancer. Hamilton, Ontario: BC Decker Inc, 2001, pp 127-141.
    Comprehensive chapter on MCC in a multi authored atlas of skin cancer.
  6. Paulson KG, Lemos BD, Feng B, Jaimes N, Penas PF, Bi X, Maher E, Cohen L, Leonard JH, Granter SR, Chin L and Nghiem P. Array-CGH reveals recurrent genomic changes in Merkel cell carcinoma including amplification of L-Myc. J Invest Dermatol. 2009 Jun;129(6):1547-55.
    28 tumor specimens from 25 MCC patients were analyzed to provide the most detailed view of MCC genetics available to date.
  7. Lemos B, Nghiem P, Merkel Cell Carcinoma: More Deaths But Still No Pathway to Blame.  Journal of Investigative Dermatology (2007) 127, 2100–2103.
    Short review of the biology of MCC.
  8. Iyer J, Nghiem P. Merkel Cell Carcinoma: An Uncommon But Often Lethal Skin Cancer.  Skin Cancer Foundation Journal (2009).
    Brief overview of MCC written in non-technical language.

Immune Suppression and MCC

  1. Engles EA, Frish M, Goedert JJ, Biggar RJ, Miller RW. Merkel cell carcinoma and HIV infection. Lancet 2002; 359:497-498.
    National Cancer Institute study that found that immune suppression from HIV increased MCC risk by roughly 8-fold.
  2. Penn I, First MR. Merkel’s cell carcinoma in organ recipients: report of 41 cases. Transplantation 1999; 68:1717-21.
    University of Cincinnati study that concluded that organ transplant patients, on drugs that suppress the immune system, have a roughly 10-fold higher risk of developing MCC, which proved to be more aggressive in this patient population.

Staging and Sentinel Lymph Node Biopsy

  1. Lemos B, Storer B, Iyer J, Phillips JL, Bichakjian CK, Fang LC, Johnson TM, Liegeois-Kwon NJ, Otley CC, Paulson KG, Ross MI, Yu SS, Zeitouni NC, Byrd DR, Sondak VK, Gershenwald JE, Sober AJ, Nghiem P. Pathologic nodal evaluation improves prognostic accuracy in Merkel cell carcinoma: Analysis of 5,823 cases as the basis of the first consensus staging system for this cancer. J Am Acad Dermatol. 63:751-61, 2010.
  2. Gupta SG, Wang LC, Penas PF, Gellenthin M, Lee SJ, Nghiem P. Sentinel lymph node biopsy for evaluation and treatment of patients with Merkel cell carcinoma: The Dana-Farber experience and meta-analysis of the literature.Archives of Dermatology 2006; 142:685-90.
    Series of MCC cases from Dana-Farber Cancer Institution and published cases found that sentinel lymph node biopsy improved staging accuracy and was thus important for prognosis and treatment. 
  3. Nghiem P, et al.  Merkel cell carcinoma, Chapter 30, AJCC Cancer Staging Manual, 2009 Springer. 
    This is the first staging chapter specific for Merkel cell carcinoma. Merkel cell carcinoma was previously included in the “Carcinoma of the Skin” chapter. Note, this staging system will be replaced in 2017 with the 8th edition


  1. Akaike G, Akaike T, Lachance K, Nghiem P, Fatemeh B. Imaging of Merkel cell Carcinoma: What experts should know 

Radiation and MCC

  1. Lewis KG, Weinstock MA, Weaver AL, Otley CC. Adjuvant local irradiation for Merkel cell carcinoma. Archives of Dermatology 2006; 142:693-700.
    Review of literature on MCC found that surgery plus local irradiation for treatment of MCC resulted in lower rates of local and regional recurrence compared to surgery alone. 
  2. Longo MI, Nghiem P. Merkel cell carcinoma treatment with radiation: a good case despite no prospective studies. Archives of Dermatology 2003; 139:1641-1643.
    Editorial that accompanied Mortier, et al paper discussing the importance of adjuvant radiation therapy and a proposed algorithm for MCC treatment.
  3. Mortier L, Mirabel X, Fournier C, Piette F, Lartigau E. Radiotherapy alone for primary Merkel cell carcinoma. Archives of Dermatology 2003; 139:1587-1590.
    French study of stage I MCC that found no difference in overall survival in treatment with radiation therapy alone (9 patients) compared with surgery and radiation therapy (17 patients).
  4. Poulsen M, Rischin D, Walpole E, Harvey J, Mackintosh J, Ainslie J, Hamilton C, Keller J, Tripcony L. High-risk Merkel cell carcinoma of the skin treated with synchronous carboplatin/etoposide and radiation: a Trans-Tasman Radiation Oncology Group Study–TROG 96:07. Journal of Clinical Oncology 2003; 21:4371-4376.
    Australian phase II study of 53 patients with stage I and II MCC treated with both chemotherapy (carboplatin/etoposide) and radiation therapy. This study showed 76% overall survival at 3 years, which was roughly similar, but perhaps better, than expected from previous studies. This study was not randomized nor controlled. 

Adjuvant Chemotherapy

  1. Lemos B, Yu S, and Nghiem P.  Case 19-2008: Merkel-Cell Carcinoma.  New England Journal of Medicine 2008; 358:2717-2723.
    A rebuttal regarding the case study of one Merkel cell carcinoma patient.
  2. Garneski KM, Nghiem P. Merkel cell carcinoma adjuvant therapy: Current data support radiation but not chemotherapyadjuvant therapy. J Am Acad Dermatol2007 July; 57(1): 166–169.
    Paper that discusses the lack of data to support using adjuvant chemotherapy in Merkel cell carcinoma .  Adjuvant chemotherapy refers to additional treatment, usually given after surgery where all detectable disease has been removed, but where there remains a statistical risk of relapse due to occult disease.

Merkel Cell Polyomavirus

  1. Bhatia S, Afanasiev O, Nghiem P. Immunobiology of Merkel Cell Carcinoma: Implications for Immunotherapy of a Polyomavirus-Associated Cancer. Curr Oncol Rep (2011) 13:488–497.
    A review of recent discoveries in MCC, focusing on the pathogenic role of MCPyV and the immunobiology of MCC.
  2. Garneski KM, Decaprio JA, Nghiem P. Does a new polyomavirus contribute to Merkel cell carcinoma? Genome Biol 2008; 9(6):228.  A review of polyomavirus biology and its possible relation to cancer.
  3. Garneski KM, Warcola AH, Feng Q, Kiviat N, Leonard JH, Nghiem P. Merkel Cell Polyomavirus Is More Frequently Present in North American than Australian Merkel Cell Carcinoma Tumors. Journal of Investigative Dermatology 2009; 129, 246–248.
    North American and Australian tumor samples were evaluated for presence of MCPyV and a higher incidence in North American samples were positive for MCPyV when compared to Australia, suggesting a possible strain variant.
  4. Feng H, Shuda M, Chang Y, Moore P.  Clonal Integration of a Polyomavirus in Human Merkel Cell Carcinoma.  Science 2008; 319:1096-1100.
    A technique called digital transcriptome subtraction (DTS) was used to identify a new virus, which is a previously unknown polyomavirus that we call Merkel cell polyomavirus (MCV or MCPyV).  MCPyV sequences were detected in 8 of 10 (80%) MCC tumors (lower incidence in non-MCC tumors).
  5. Carter J, Paulson K, Wipf G, Miranda D, Madeleine M, Johnson L, Lemos B, Lee S, Warcola A, Iyer J, Nghiem P, Galloway D.  Association of Merkel Cell Polyomavirus–Specific Antibodies With Merkel Cell Carcinoma.  Journal of the National Cancer Institute (JNCI), Nov 4, 2009, 101(21): 1-13.
    Merkel cell polyomavirus (MCPyV) has been detected in approximately 75% of patients with the rare skin cancer Merkel cell carcinoma. We investigated the prevalence of antibodies against MCPyV in the general population and the association between these antibodies and Merkel cell carcinoma.