Letter - Clinical
Giant, aggressive Merkel cell carcinoma of the right arm
Read
4025
Timeswas read the article
1514
Total PDF
2511
Total HTML
Share statistics
array:23 [ "pii" => "S036505962200280X" "issn" => "03650596" "doi" => "10.1016/j.abd.2021.11.010" "estado" => "S300" "fechaPublicacion" => "2023-03-01" "aid" => "673" "copyrightAnyo" => "2022" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by/4.0/" "subdocumento" => "crp" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "pt" => array:18 [ "pii" => "S2666275222002922" "issn" => "26662752" "doi" => "10.1016/j.abdp.2021.11.024" "estado" => "S300" "fechaPublicacion" => "2023-03-01" "aid" => "673" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by/4.0/" "subdocumento" => "crp" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "pt" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta – Caso Clínico</span>" "titulo" => "Carcinoma de células de Merkel gigante e agressivo no braço direito" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "252" "paginaFinal" => "255" ] ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figura 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 2007 "Ancho" => 1508 "Tamanyo" => 338973 ] ] "descripcion" => array:1 [ "pt" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Aspecto da lesão após radioterapia (primeiro ciclo) e desbridamento cirúrgico.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Piotr Brzeziński, Justyna Słomka, Aleksandra Kitowska, Cesar Bimbi" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Piotr" "apellidos" => "Brzeziński" ] 1 => array:2 [ "nombre" => "Justyna" "apellidos" => "Słomka" ] 2 => array:2 [ "nombre" => "Aleksandra" "apellidos" => "Kitowska" ] 3 => array:2 [ "nombre" => "Cesar" "apellidos" => "Bimbi" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S036505962200280X" "doi" => "10.1016/j.abd.2021.11.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S036505962200280X?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275222002922?idApp=UINPBA00008Z" "url" => "/26662752/0000009800000002/v1_202302281436/S2666275222002922/v1_202302281436/pt/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S0365059622002781" "issn" => "03650596" "doi" => "10.1016/j.abd.2021.03.018" "estado" => "S300" "fechaPublicacion" => "2023-03-01" "aid" => "671" "copyright" => "Sociedade Brasileira de Dermatologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by/4.0/" "subdocumento" => "crp" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter - Clinical</span>" "titulo" => "Keratotic papules on the thigh: underrecognized skin manifestations of dermatomyositis or Wong-type dermatomyositis?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "255" "paginaFinal" => "257" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1651 "Ancho" => 2175 "Tamanyo" => 1130766 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histological features showing keratotic plug, epidermal atrophy, liquefaction of the basal layers, individual cell keratinization, and mononuclear cell infiltration in the upper dermis: (Hematoxylin & eosin 100 ×).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Miyuki Yamamoto, Toshiyuki Yamamoto" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Miyuki" "apellidos" => "Yamamoto" ] 1 => array:2 [ "nombre" => "Toshiyuki" "apellidos" => "Yamamoto" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275222002909" "doi" => "10.1016/j.abdp.2022.12.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275222002909?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059622002781?idApp=UINPBA00008Z" "url" => "/03650596/0000009800000002/v1_202302171515/S0365059622002781/v1_202302171515/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0365059622002793" "issn" => "03650596" "doi" => "10.1016/j.abd.2021.10.015" "estado" => "S300" "fechaPublicacion" => "2023-03-01" "aid" => "672" "copyright" => "Sociedade Brasileira de Dermatologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by/4.0/" "subdocumento" => "crp" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter - Clinical</span>" "titulo" => "Case for diagnosis. Hair analysis in a child with delayed psychomotor development and fragile and brittle hair: Trichothiodystrophy" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "250" "paginaFinal" => "252" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1366 "Ancho" => 1675 "Tamanyo" => 121792 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Examination of the hair under a polarized microscope: trichoscisis with typical “tiger-tail pattern”. Note the alternating dark and light transverse banding.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Irene López Riquelme, Alberto Andamoyo Castañeda, Elisabeth Gómez Moyano, Ángel Vera Casaño" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Irene" "apellidos" => "López Riquelme" ] 1 => array:2 [ "nombre" => "Alberto" "apellidos" => "Andamoyo Castañeda" ] 2 => array:2 [ "nombre" => "Elisabeth" "apellidos" => "Gómez Moyano" ] 3 => array:2 [ "nombre" => "Ángel" "apellidos" => "Vera Casaño" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275222002910" "doi" => "10.1016/j.abdp.2022.12.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275222002910?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059622002793?idApp=UINPBA00008Z" "url" => "/03650596/0000009800000002/v1_202302171515/S0365059622002793/v1_202302171515/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter - Clinical</span>" "titulo" => "Giant, aggressive Merkel cell carcinoma of the right arm" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">Dear Editor,</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "252" "paginaFinal" => "255" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Piotr Brzeziński, Justyna Słomka, Aleksandra Kitowska, Cesar Bimbi" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Piotr" "apellidos" => "Brzeziński" "email" => array:1 [ 0 => "brzezoo77@yahoo.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Justyna" "apellidos" => "Słomka" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Aleksandra" "apellidos" => "Kitowska" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Cesar" "apellidos" => "Bimbi" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Department of Physiotherapy and Medical Emergency, Faculty of Health Sciences, Pomeranian Academy, Slupsk, Poland" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Dermatology, Provincial Specialist Hospital in Slupsk, Ustka, Poland" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Private Clinic, Porto Alegre, RS, Brazil" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 2007 "Ancho" => 1508 "Tamanyo" => 340647 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0035" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Condition after radiotherapy (first cycle) and surgical debridement.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In october 2018, a 65-year-old woman consults for a red, hot, painful, edematous lesion on the skin of the right arm.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Within two months of the tumor appearance, its volume increased fourfold (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The physical examination revealed an erythematous tumor 1.5 cm in diameter, movable in relation to the substrate, and poorly demarcated from the surroundings. History of comorbidities: chronic lymphocytic leukemia B-cell BCLL-PD (treated with Ofatumumab + Chlorambucil, 2008–2009).</p><p id="par0020" class="elsevierStylePara elsevierViewall">The laboratory abnormalities showed a markedly elevated level of leukocytes: 89,600 (N: 4–10).</p><p id="par0025" class="elsevierStylePara elsevierViewall">A 2.0 × 0.7 cm skin section with a subcutaneous tissue thickness of 0.6 cm was taken for evaluation.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In the histopathological examination of the dermis, diffuse infiltration of hyperchromatic atypical cells with a scanty cytoplasm of immunophenotype: CKAE1/3(+)"dot-like", CK20(+)"dot-like", SYN(+), CgA(±), TTF-1(−), LCA(-), Ki67(+) approx. 90%. The whole picture speaks in favor of cutaneous neuroendocrine carcinoma (Merkel cell carcinoma) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A and B).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The patient was transferred to the oncological surgeryward for further treatment. At the beginning of november 2018, the sentinel lymph node biopsy of the right armpit was performed together with the excision of the tumor of the right arm.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In the histopathological examination: lymph nodes with obliterated structure with infiltration of small lymphocytes of immunophenotype: CD3(−), CD20(+), CD5(+), CD23(+), cyclin D1(−), Ki67(+) 20%. The whole picture corresponds to the infiltration of small B Lymphocytes (B-SLL/CLL). In the immunohistochemical test: CKAE1/3(−), CgA(−). The histopathological exam after the excision of a skin tumor confirmed Merkell cell carcinoma.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The cycle of six chemotherapy has started (Cisplatin, Etoposide, Netupitant Palonosetron, Dexamethasone, Mannitol).</p><p id="par0050" class="elsevierStylePara elsevierViewall">Since august 2019, aggressive disease recurred (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A). Physical examination revealed an overgrown tumor of the right arm (35 × 16 cm) in the peak phase before radiotherapy) with a cohesive consistency, a solid arrangement of nest-like masses, surrounded by inflammation. Moreover, in the area of the right armpit and the right side, enlarged, inflammatory lymph node packages (metastases) were observed (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>B).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Laboratory tests: lactate dehydrogenase ‒ LDH: 950, CRP: 213.</p><p id="par0060" class="elsevierStylePara elsevierViewall">In september, started low voltage, local radiotherapy treatment of 120 Gy per fraction of 20 Gy, in 6 sessions.</p><p id="par0065" class="elsevierStylePara elsevierViewall">After the important improvement after the second session (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>) and the surgical debridement of the tumor, there were new metastases.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Unfortunatley the patient died in december after 1.5 years from the Merkel cell carcinoma diagnosis.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">Merkel cell carcinoma is an aggressive neuroendocrine carcinoma with a high rate of metastasis and 5-year overall survival<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a>.</p><p id="par0080" class="elsevierStylePara elsevierViewall">It occurs preferentially in the elderly or immunocompromised and is most often localized in a photoexposed area, in particular on the face. The average age at diagnosis being 69 years<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>.</p><p id="par0085" class="elsevierStylePara elsevierViewall">The discovery of a new polyomavirus, McPyV, has shed a different light on the pathogenesis of this tumor. The integration of a polyomavirus-like virus clone into the genome of Merkel tumor cells has been objectified (named “Merkel cell polyomavirus” ‒ MCPyV), thus suggesting a viral etiology. However, the viral infection alone is not enough to induce a malignant transformation<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a>.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Currently, it is still unclear whether the polyomavirus is associated with MCC or the UV is associated with MCC.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Due to the clinically unspecific primary lesion, the clinical diagnosis of Merkel cell carcinoma it is often done late. The acronym AEIOU was developed to provide assistance in finding the diagnosis: A = Asymptomatic/lack of tenderness, E = Expanding rapidly (doubling in 3 months), I = Immunosuppression, O = Older than 50 years, U = Ultraviolet-exposed skin site<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>. Our case met the five above criteria.</p><p id="par0100" class="elsevierStylePara elsevierViewall">So far, 12 cases of giant MCC tumors have been described.</p><p id="par0105" class="elsevierStylePara elsevierViewall">The largest tumor of the MCC was described by authors from the USA on the right forearm of an 84-year-old man (23 × 18 cm)<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>. This particular patient responded well to radiation therapy.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Authors from Italy described a giant Merkel cell carcinoma of the left arm of a 76-years-old woman (13 × 10 cm)<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>.</p><p id="par0115" class="elsevierStylePara elsevierViewall">So far, a larger tumor than the one we presented has not been described (35 × 16 cm).</p><p id="par0120" class="elsevierStylePara elsevierViewall">The treatment of choice for MCC is still the complete excision with a 1–2 cm safety margin and subsequent irradiation in the tumor bed regional lymph node stations<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>.</p><p id="par0125" class="elsevierStylePara elsevierViewall">Regardless of the SLNB result, adjuvant irradiation of the primary tumor bed is recommended for all patients.</p><p id="par0130" class="elsevierStylePara elsevierViewall">Advances in the treatment of MCC in recent years have led to the FDA-approved drug ‒ the immune checkpoint inhibitor avelumab, a PD-1 antagonist.</p><p id="par0135" class="elsevierStylePara elsevierViewall">In the case of our patient, this drug was reported to the Polish healthcare system in order to obtain it for treatment. However, the patient did not manage to take this drug.</p><p id="par0140" class="elsevierStylePara elsevierViewall">The course of MCC is rarely as aggressive and as fast as in our patient. Failure of chemotherapy and radiotherapy, multiple metastases, and death 1.5 years after diagnosis were certainly related to the deficiency of the immune system.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Financial support</span><p id="par0145" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Authors' contributions</span><p id="par0150" class="elsevierStylePara elsevierViewall">Piotr Brzeziński: Concepts; Design; Clinical studies; Data acquisition; Statistical analysis; Manuscript preparation.</p><p id="par0155" class="elsevierStylePara elsevierViewall">Justyna Słomka: Concepts; Design; Definition of intellectual content; Clinical studies; Data analysis; Manuscript preparation; Manuscript editing; Manuscript review.</p><p id="par0160" class="elsevierStylePara elsevierViewall">Aleksandra Kitowska: Clinical studies; Data acquisition; Data analysis; Statistical analysis.</p><p id="par0165" class="elsevierStylePara elsevierViewall">César Bimbi: Definition of intellectual content; Clinical studies; Data analysis; Statistical analysis; Manuscript editing; Manuscript review.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflicts of interest</span><p id="par0170" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Discussion" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Financial support" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Authors' contributions" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflicts of interest" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-09-28" "fechaAceptado" => "2021-11-08" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Department of Dermatology, Provincial Specialist Hospital in Slupsk, Ustka, Poland.</p>" ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2008 "Ancho" => 1508 "Tamanyo" => 416403 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A large pink, erythematous nodule on the skin of the right arm.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1198 "Ancho" => 3389 "Tamanyo" => 776404 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Typical histopathologic appearance of Merkel cell carcinoma. (A) Large nodular collections crowded basaloid cells in the dermis and subcutis with foci of necrosis. Aggregations of tumor cells form interanastamosing cords in the dermis in a trabecular pattern with some infiltrate strands of cells in the deep reticular dermis, (Hematoxylin & eosin, 100×).</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(B) CK-20 immunohistochemical staining in merkel cell carcinoma shows a paranuclear dot pattern. CK-20 40×.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2087 "Ancho" => 3341 "Tamanyo" => 693535 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">(A) Recurred of disease ‒ Giant, outgrown MCC tumor (01. September). (B) Multiple subcutaneous in transit metastases of an MCC.</p>" ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 2007 "Ancho" => 1508 "Tamanyo" => 340647 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0035" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Condition after radiotherapy (first cycle) and surgical debridement.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Advanced Merkel cell carcinoma-A focus on medical drug therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "U. Wollina" 1 => "A. Koch" 2 => "J.C. Cardoso" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Dermatol Ther" "fecha" => "2020" "volumen" => "33" "itemHostRev" => array:3 [ "pii" => "S1473309910701389" "estado" => "S300" "issn" => "14733099" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Molecular detection of Merkel cell polyomavirus in basal cell carcinoma and perilesional tissue: a cross-sectional study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.T.V. Gonçalves" 1 => "R.B. Varella" 2 => "N.K.O. Almeida" 3 => "M.A.A.M. Guimarães" 4 => "F.B. Luz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.abd.2019.10.007" "Revista" => array:7 [ "tituloSerie" => "An Bras Dermatol" "fecha" => "2020" "volumen" => "95" "paginaInicial" => "527" "paginaFinal" => "528" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32499100" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1473309917304747" "estado" => "S300" "issn" => "14733099" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Merkel cell carcinoma versus metastatic small cell primary bronchogenic carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A.M. Abreu Velez" 1 => "B.L. Jackson" 2 => "K.L. Velasquez Cantillo" 3 => "A.R. Benavides Alvarez" 4 => "M.S. Howard" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Our Dermatol Online" "fecha" => "2013" "volumen" => "4" "paginaInicial" => "64" "paginaFinal" => "71" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Merkel Cell Carcinoma Review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Y. Xue" 1 => "M. Thakuria" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.hoc.2018.08.002" "Revista" => array:6 [ "tituloSerie" => "Hematol Oncol Clin North Am" "fecha" => "2019" "volumen" => "33" "paginaInicial" => "39" "paginaFinal" => "52" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30497676" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Immunobiology of Merkel cell carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Samimi" 1 => "T. Kervarrec" 2 => "A. Touze" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/CCO.0000000000000608" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Oncol" "fecha" => "2020" "volumen" => "32" "paginaInicial" => "114" "paginaFinal" => "121" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31972727" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical characteristics of Merkel cell carcinoma at diagnosis in 195 patients: the AEIOU features" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Heath" 1 => "N. Jaimes" 2 => "B. Lemos" 3 => "A. Mostaghimi" 4 => "L.C. Wang" 5 => "P.F. Peñas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2007.11.020" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2008" "volumen" => "58" "paginaInicial" => "375" "paginaFinal" => "381" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18280333" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Giant Merkel cell carcinoma involving the upper extremity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K. Hapcic" 1 => "J. Panchal" 2 => "J. Stewart" 3 => "N. Levine" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1046/j.1524-4725.2001.00314.x" "Revista" => array:6 [ "tituloSerie" => "Dermatol Surg" "fecha" => "2001" "volumen" => "27" "paginaInicial" => "493" "paginaFinal" => "494" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11359501" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Giant Merkel cell carcinoma of the left arm. Case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R. Sivelli" 1 => "A. Ghirarduzzi" 2 => "P. Del Rio" 3 => "R. Ricci" 4 => "M. Sianesi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Ital Chir" "fecha" => "2009" "volumen" => "80" "paginaInicial" => "489" "paginaFinal" => "492" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20476686" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Collision tumor: Merkel cell carcinoma and sebaceous carcinoma overlying Bowen’s disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Rupchandani" 1 => "T. Umar" 2 => "S. Walsh" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Our Dermatol Online" "fecha" => "2021" "volumen" => "12" "paginaInicial" => "277" "paginaFinal" => "279" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03650596/0000009800000002/v1_202302171515/S036505962200280X/v1_202302171515/en/main.assets" "Apartado" => array:4 [ "identificador" => "95153" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter - Clinical" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03650596/0000009800000002/v1_202302171515/S036505962200280X/v1_202302171515/en/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S036505962200280X?idApp=UINPBA00008Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 17 | 9 | 26 |
| 2024 October | 98 | 76 | 174 |
| 2024 September | 126 | 85 | 211 |
| 2024 August | 138 | 115 | 253 |
| 2024 July | 125 | 96 | 221 |
| 2024 June | 117 | 70 | 187 |
| 2024 May | 101 | 63 | 164 |
| 2024 April | 85 | 75 | 160 |
| 2024 March | 105 | 56 | 161 |
| 2024 February | 143 | 81 | 224 |
| 2024 January | 88 | 57 | 145 |
| 2023 December | 91 | 70 | 161 |
| 2023 November | 125 | 82 | 207 |
| 2023 October | 116 | 81 | 197 |
| 2023 September | 257 | 91 | 348 |
| 2023 August | 147 | 32 | 179 |
| 2023 July | 125 | 41 | 166 |
| 2023 June | 75 | 51 | 126 |
| 2023 May | 67 | 23 | 90 |
| 2023 April | 83 | 34 | 117 |
| 2023 March | 117 | 76 | 193 |
| 2023 February | 72 | 53 | 125 |
| 2023 January | 54 | 61 | 115 |
| 2022 December | 39 | 36 | 75 |
Show all
