Subcutaneous Merkel Cell Carcinoma in a Psoriatic Patient Treated with Methotrexate and TNF-α inhibitors

Abstract

TNF-α inhibitors are used for the treatment of chronic inflammatory diseases and provide a high degree of clinical efficacy in patients with severe psoriasis. Although the effect of blocking agents gives significant improvements in quality of life of psoriatic patients, the use of them might lead to neoplasia not observed before the treatment. We present a case of Merkel cell carcinoma in a patient with a long-standing history of psoriasis and psoriatic arthritis treated with methotrexate and TNF-α inhibitors (etanercept and infliximab).

Zusammenfassung

TNF-α-Inhibitoren werden neben verschiedenen chronisch entzündlichen Krankheiten auch zur Therapie der schweren Psoriasis eingesetzt. Die Therapie führt zu einer deutlichen Verbesserung der Lebensqualität der Psoriasis-Patienten, kann aber unter Umständen eine rasche Progression maligner Tumore begünstigen, die vor der Behandlung nicht diagnostiziert wurden. Wir berichten über einen klinischen Fall des Merkelzellkarzinoms bei einem Patienten mit langjähriger Psoriasis und Psoriasis-Arthritis, der mit Methotrexat und TNF-α-Inhibitoren (Etanercept und Infliximab) behandelt wurde.

• References

• 1 Howard RA, Dores GM, Curtis RE et al. Merkel cell carcinoma and multiple primary cancers. Cancer Epidemiol Biomarkers Prev 2006; 15: 1545
• 2 Manganoni MA, Farisoglio C, Tucci G et al. Merkel cell carcinoma and HIV infection: a case report and review of the literature. AIDS Patient Care STDS 2007; 21: 447
• 3 Koljonen V, Kukko H, Tukiainen E et al. Incidence of Merkel cell carcinoma in renal transplant recipients. Nephrol Dial Transplant 2009; 24: 3231
• 4 Pathirana D, Ormerod AD, Saiag P et al. European S3-Guidelines on the systemic treatment of psoriasis vulgaris. JEADV 2009; 23: 5-70
• 5 Younger IR, Harris DWS, Colver GB. Azatiophrine in dermathology. J Am Acad Dermatol 1991; 25: 281-286
• 6 Gooptu C, Woollons A, Ross J et al. Merkel cell carcinoma arising after therapeutic immunosuppression. British Journal of Dermatol 1997; 137: 637-641
• 7 Krishna SM, Kim CN. Merkel cell carcinoma in a patient treated with adalimumab: case report. Cutis 2011; 87: 81-84
• 8 Wirges ML, Saporito F, Smith J. Rapid growth of Merkel cell carcinoma after treatment with rituximab. J Drugs Dermatol 2006; 5: 180-181
• 9 Moulis G, Sommet A, Bene J et al. Cancer Risk of Anti-TNF-α at Recommended Doses in Adult Rheumatoid Arthritis: A Meta-Analysis with Intention to Treat and per Protocol Analyses. Plos One 2012; 7: 1-7
• 10 Morgan MB, Smoller BR, Somach SC. Deadly dermatologic diseases: Merkel Cell Carcinoma. Clinicopathologic Atlas and Text 2007; Part I.VIII: 32-38
• 11 Koljonen V, Kluger N, Sihto H et al. Lateral distribution of Merkel cell carcinoma in a nationwide cohort. J Eur Acad Dermatol Venereol 2013; 27: 884-888
• 12 Agelli M, Clegg LX. Epidemiology of primary Merkel cell carcinoma in the United States. J Am Acad Dermatol 2003; 49: 832
• 13 Lunder EJ, Stern RS. Merkel-Cell Carcinomas in Patients Treated with Methoxsalen and Ultraviolet A Radiation. N Engl J Med 1998; 339: 1247-1248
• 14 Chang Y, Moore PS. Merkel Cell Carcinoma: A Virus-Induced Human Cancer. Annu Rev Pathol Mech Dis 2012; 7: 123-144
• 15 Feng H, Shuda M, Chang Y et al. Clonal integration of a polyomavirus in human Merkel cell carcinoma. Science 2008; 319: 1096
• 16 Kassem A, Schöpflin A, Diaz C et al. Frequent detection of Merkel cell polyomavirus in human Merkel cell carcinomas and identification of a unique deletion in the VP1 gene. Cancer Res 2008; 68: 5009
• 17 Sharp CP, Norja P, Anthony I et al. Reactivation and mutation of newly discovered WU, KI, and Merkel cell carcinoma polyomaviruses in immunosuppressed individuals. J Infect Dis 2009; 199: 398
• 18 Carter JJ, Paulson KG, Wipf GC et al. Association of Merkel cell polyomavirus-specific antibodies with Merkel cell carcinoma. J Natl Cancer Inst 2009; 101: 1510
• 19 Wang TS, Byrne PJ et al. Merkel Cell Carcinoma: Update and Review. Semin Cutan Med Surg 2011; 30: 48-56
• 20 Sastre-Garau X, Peter M, Avril MF et al. Merkel cell carcinoma of the skin: pathological and molecular evidence for a causative role of MCV in oncogenesis. J Pathol 2009; 218: 48
• 21 Schrama D, Peitsch WK, Zapatka M et al. Merkel cell polyomavirus status is not associated with clinical course of Merkel cell carcinoma. J Invest Dermatol 2011; 131: 1631
• 22 Duncavage EJ, Le BM, Wang D et al. Merkel cell polyomavirus: a specific marker for Merkel cell carcinoma in histologically similar tumors. Am J Surg Pathol 2009; 33: 1771-1777
• 23 Chen T, Hedman L, Matilla PS et al. Serological evidence of Merkel cell polyomavirus primary infections in childhood. J Clin Virol 2011; 50: 125-129