Gender and immunosuppression impact on Merkel cell carcinoma diagnosis and prognosis. A population based cohort study

E Keeling; E O'Leary; S Deady; J P O Neill; P J Conlon; F J Moloney

doi:10.1002/ski2.80

Gender and immunosuppression impact on Merkel cell carcinoma diagnosis and prognosis. A population based cohort study

Skin Health Dis. 2021 Dec 8;2(1):e80. doi: 10.1002/ski2.80. eCollection 2022 Mar.

Authors

E Keeling¹, E O'Leary², S Deady², J P O Neill^{3

4}, P J Conlon^{4

5}, F J Moloney^{6

7

8}

Affiliations

¹ Department of Dermatology Tallaght University Hospital Dublin Ireland.
² National Cancer Registry Cork Ireland.
³ Otolaryngology Department Beaumont Hospital Dublin Ireland.
⁴ Royal College of Surgeons in Ireland Dublin Ireland.
⁵ Nephrology Department Beaumont Hospital Dublin Ireland.
⁶ Department of Dermatology Mater Misericordiae University Hospital Dublin Ireland.
⁷ School of Medicine University College Dublin Dublin Ireland.
⁸ Melanoma Institute Australia Sydney New South Wales Australia.

PMID: 35665203
PMCID: PMC9060007
DOI: 10.1002/ski2.80

Abstract

Background: Merkel cell carcinoma (MCC), a rare cutaneous neuroendocrine endocrine tumour is increasing in incidence, and continues to carry a poor prognosis.

Objectives: The objectives of this study were to examine all Irish cases of MCC from 1 January 1994 over 2 decades, focusing on gender and organ transplantation recipients (OTRs). Cases were identified from the National Cancer Registry of Ireland. Covariates of interest included age, body site, period of diagnosis, deprivation-status and history of non-melanoma skin cancer (NMSC).

Results: In total 314 MCC cases were identified. A female predominance was noted (53.8%). Comparison between age-standardised rates between the earliest period (1994-1996) with the latest period (2012-2014) showed an increase of 105% in total. The trend in age-standardised incidence rates were noted to be increasing significantly (p = 0.0004). Average age at diagnosis was 77.6 years (male 75.1 years, female 79.7 years). Overall, the majority of MCC cases presented on the head and neck (n = 170, 54.1%). Differences in anatomical location of MCCs were noted between genders. Males were found to be more likely to have a history of previous NMSCs (males n = 73 [57.9%], females n = 53 [42.1%]). Thirty-one percentage of patients died from MCC, average survival was 3.5 years in those who died of this malignancy. Ten organ transplant recipients developed MCC. OTR who developed MCC were diagnosed at a younger average age of 65.1 years. Standardized incidence ratio for MCC in OTR was 59.96. A higher proportion of OTR died from MCC (70%), with a shorter median survival of 0.14 years. In competing risks regression, gender was not significantly associated with risk of dying, females having a non-significantly higher hazard of dying. Organ transplant recipients and patients from less deprived areas were at greater risk of dying from MCC.

Conclusions: This population based study provides epidemiological, clinical and outcome data for MCC over a 20-year period.