Treatment

Treatments for Merkel cell carcinoma can include:

• Surgery. During surgery, your doctor removes the tumor along with a border of normal skin surrounding the tumor. If there's evidence that the cancer has spread to lymph nodes in the area of the skin tumor, those lymph nodes are removed (lymph node dissection).

  The surgeon most often uses a scalpel to cut away the cancer. In some cases, your doctor may use a procedure called Mohs surgery.

  During Mohs surgery, thin layers of tissue are methodically removed and analyzed under a microscope to see whether they contain cancer cells. If cancer is found, the surgical process is repeated until cancer cells are no longer visible in the tissue. This type of surgery takes out less normal tissue — thereby reducing scarring — but ensures a tumor-free border of skin.

• Radiation therapy. Radiation therapy involves directing high-energy beams, such as X-rays and protons, at cancer cells. During radiation treatment, you're positioned on a table and a large machine moves around you, directing the beams to precise points on your body.

  Radiation therapy is sometimes used after surgery to destroy any cancer cells that remain after the tumor is removed.

  Radiation may also be used as the sole treatment in people who choose not to undergo surgery. Radiation can also be used to treat areas where the cancer has spread.

• Immunotherapy. In immunotherapy, drugs are used to help your immune system fight cancer. Most often, immunotherapy is used to treat Merkel cell carcinoma that has spread to other areas of your body.

• Chemotherapy. Chemotherapy uses drugs to kill the cancer cells. Chemotherapy drugs can be administered through a vein in your arm or taken as a pill or both.

  Chemotherapy is not used often, but your doctor may recommend it if your Merkel cell carcinoma has spread to your lymph nodes or other organs in your body, or if it has returned despite treatment.