Merkel Cell Carcinoma Treatment

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There are different treatment options for Merkel cell carcinoma (MCC) depending on what stage your disease is and other factors such as your overall health. Fred Hutch Cancer Center has one of the most active MCC clinical and research programs in the world, including advanced therapies and options available through clinical trials not offered elsewhere.

We will closely monitor you during and after treatment. Depending on your situation, this surveillance may include scans, blood-based biomarker tests like AMERK (anti-Merkel cell panel) or ctDNA (circulating tumor DNA) and regular physical exams.

Merkel Cell Carcinoma Care Tailored to You

You and your family are our top priority. At Fred Hutch Cancer Center, we offer comprehensive and compassionate care — personalized to you. You'll have access to the latest treatment options, clinical trials and supportive care services. 

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How We Diagnose Merkel Cell Carcinoma at Fred Hutch

Merkel cell carcinomas are diagnosed with a skin biopsy, which means samples of cells are taken from the tumor and sent to a lab where they are examined under a microscope by a pathologist. Common types of biopsies include:

  • Punch biopsy, which takes a small cylinder of tissue
  • Shave biopsy, which removes the part of the top of the abnormal tissue with a scalpel
  • Sentinel lymph node biopsy, which removes and checks the first lymph node to which the cancer may have spread — before surgery to remove the tumor itself

If you have already been diagnosed with MCC and are coming to Fred Hutch for a consultation, we will ask to have your pathology slides sent to us in advance to confirm your diagnosis.

How We Treat Early Merkel Cell Carcinoma at Fred Hutch

Surgery and radiation therapy are the most common treatments for people with stage I (1) or II (2) MCC. This is early-stage MCC, when the main tumor has not spread to lymph nodes or other parts of the body.

Each week, there is a tumor board meeting for MCC specialists from around the world to discuss complex patient cases and decide on the most effective treatment approach. (A tumor board is a meeting where specialists from different fields review patient cases together to recommend the best treatment plan.) The MCC tumor board is led by the Merkel Cell Carcinoma Collaborative (MC3) Institute research clinical fellows — physicians and medical students training in MCC — alongside Fred Hutch physicians.

Surgery

If you have early-stage Merkel cell carcinoma, you likely will have surgery to remove the tumor. Often surgeons perform a procedure called wide surgical excision, which takes out the cancer and some of the skin around it.

The MCC team includes experts in surgical oncology, reconstruction and head and neck surgery. They specialize in the treatment of MCC, and you can feel confident knowing that the surgeon who cares for you is best suited for your specific diagnosis.

Reconstructive Surgery

If you have a wide surgical excision, your surgeon may be able to close the area by bringing the edges around the wound together. If this is not possible — for instance, the area is too large or the cancer went too deep — a Fred Hutch reconstructive surgeon can offer more options, such as:

  • Local tissue rearrangement: This procedure involves closing the wound using nearby skin that is turned into place.
  • Skin grafting: Skin grafting uses skin from another part of your body to repair your wound.
  • Free-flap reconstruction: This procedure uses skin plus other tissue from another body area to repair the damaged area.

Learn more about reconstructive surgery.

Mohs Surgery

Depending on the size and location of your tumor, your care team may recommend Mohs micrographic surgery. This method helps maintain your function and appearance in sensitive areas, like your face. The surgeon removes one thin layer of tissue at a time and each layer is examined under a microscope to see if another layer needs to be removed to get all the tumor.

Surgery and Another Treatment

Although surgery can be effective, the rate of local recurrence (cancer coming back to the same place) is high in people with MCC who have surgery as their only treatment. When the removed tissue is examined under a microscope, the margins (edges) may be free of cancer, suggesting that surgery got it all. But because of the way MCC spreads, cancer cells often are difficult to detect in neighboring tissue. Because of this, another type of treatment (usually radiation therapy) is used along with surgery to help ensure any remaining cancer cells are destroyed.

Radiation Therapy

Radiation therapy is the treatment of cancer with beams of high energy or particles that can destroy cancer cells. MCC is sensitive to radiation therapy. Radiation therapy often is used after surgery to treat the tumor site and possibly to treat the lymph nodes in the same region of the body. Radiation done after surgery is called “adjuvant” radiation therapy. Research shows that the risk of the MCC coming back is lower if radiation therapy is performed within 8 weeks after surgery to kills the remaining MCC cells and prevent them from spreading.

There is evidence that in some people, radiation alone may be a treatment option, but this is case-by-case and should be discussed with the doctors treating your MCC.

Learn More About Radiation Therapy

Treatment for Advanced Merkel Cell Carcinoma

Treatment for advanced disease may involve a combination of surgery, radiation therapy and systemic therapy, which treats cancer throughout your body, like immunotherapy or chemotherapy.

Surgery and Radiation Therapy

If you have more advanced MCC that has spread to nearby lymph nodes but not to other parts of your body (stage III), you are likely to have surgery to remove the cancer followed by radiation to the main site as well as the regional (nearby) lymph nodes.

Immunotherapy

If your cancer has spread to distant parts of your body (stage IV), you may need systemic therapy, which targets the entire body to kill cancer cells. Until recently, most patients were treated with chemotherapy, which usually only provided about three months of cancer control. Now, treatments designed to stimulate your own immune system — called immunotherapies — often are used to treat MCC, and are often far more effective than chemotherapy for this cancer.

Learn More About Immunotherapy

Immune checkpoint inhibitors

The most promising option for MCC that has spread is a class of drugs called immune checkpoint inhibitors (ICIs).

Avelumab

In March 2017, the U.S. Food and Drug Administration approved the first treatment for metastatic MCC with the ICI, avelumab (Bavencio). Fred Hutch was one of the leading sites for a clinical trial testing this medicine. 

In the study, avelumab was used to treat 88 patients who had metastatic MCC that had come back despite at least one round of chemotherapy. Tumors in 28 of those patients shrank or disappeared in response to avelumab. Among patients who initially responded to the medicine, over 80% had responses lasting more than a year.

Many patients not only did well, without evidence of active cancer after they were treated with immunotherapy for MCC, but also had very good quality of life while receiving this therapy.

Pembrolizumab

Another ICI, pembrolizumab (Keytruda), has shown promise. The National Comprehensive Cancer Network (NCCN), which publishes treatment guidelines based on expert opinion, added pembrolizumab to its list of MCC treatment options in 2017 after research showed it shrunk many tumors and provided long-lasting results. NCCN has also listed the ICIs avelumab and nivolumab (Opdivo) as preferred treatments over chemotherapy for metastatic MCC.

Other Immune Checkpoint Inhibitors

Other ICIs, including ipilimumab (Yervoy), are being studied in clinical trials for people with advanced MCC. In addition, several other immunotherapy approaches are being investigated, including intra-tumoral injections and infusion of immune cells (T-cells). Initial results suggest a promising future for immunotherapies in treating MCC.

Chemotherapy

In general, chemotherapy is only used for late stages of MCC, when immunotherapy is not an option or has failed to work. For people who do not have problems with their immune system (no autoimmune disease and no major immunosuppressive medications), physicians typically recommend first trying an immunotherapy for MCC (such as an immune checkpoint inhibitor) before using chemotherapy.

Minimizing Immunosuppression

People whose immune system isn’t functioning at a normal level are at increased risk for MCC. For instance, people who have immune systems that are suppressed — because of human immunodeficiency virus (HIV), a solid organ transplant or chronic lymphocytic leukemia or another cancer — are more likely to get MCC, and their disease is more likely to recur.

Reducing immunosuppression can be part of the therapy for MCC. If there’s any way to decrease your immunosuppression, this may help your body control the cancer.

Why Choose Fred Hutch for Merkel Cell Carcinoma Treatment

At Fred Hutch, we understand this may be one of the most intense and challenging experiences you and your family ever go through. We are here to provide the care you need.

World-Renowned Merkel Cell Carcinoma Experts

We have one of the most active MCC clinical trials and research programs in the world, led by Paul Nghiem, MD, PhD. Dr. Nghiem is a dermatologist and scientist at the forefront of MCC care who is director of the Fred Hutch Skin Oncology Clinical Program. He is also the founder of the Merkel Cell Carcinoma Collaborative (MC3) Institute, which leads MCC clinical trials, conducts MCC research, and cares for patients with MCC. Dr. Nghiem and his lab’s work.

We have dermatologists, surgeons, medical oncologists, radiation oncologists and nurses who specialize in MCC; the most advanced diagnostic, treatment and recovery programs; and extensive support.

Merkel Cell Carcinoma Treatment Tailored to You

We view treatment as a collaborative effort. Your Fred Hutch physicians will explain all your options and recommend a treatment plan based on the stage of your cancer and your overall health. Additional experts in supportive care who specialize in treating people with cancer will be involved if you need them — experts such as palliative care professionals, social workers, physical therapists and registered dietitians.

Innovative Merkel Cell Carcinoma Treatments

Fred Hutch patients have access to advanced treatments for MCC being explored in clinical trials conducted here and at UW Medicine. The Merkel Cell Carcinoma Collaborative Institute, which launched in January 2025, represents the next chapter in MCC research and care at UW Medicine and Fred Hutch.

Paris Malachias and family
Paris Malachias, center, and his family visiting Malachias' village church in 2024 on the Greek island of Chios. Courtesy of the Malachias family

A Rare Skin Cancer Diagnosis Requires a Balancing Act Between Suppressing and Boosting the Immune System

As a kidney transplant recipient, Paris Malachias was accustomed to dealing with skin cancer. It’s a common side effect of post-transplant immunosuppressants, which leave transplant recipients extra sensitive to sun, and Malachias had developed multiple basal cell carcinomas over the years. But in the fall of 2022, he noticed a pimple on his face that didn’t look like the lesions he’d had removed.

When it didn’t go away, a dermatologist biopsied it. The results came back with Merkel cell carcinoma.

Read Paris' Story

Merkel Cell Carcinoma Treatment FAQ

The stage of MCC, which includes how far the cancer has spread, will play a large part in the recommended treatment plan for a patient with MCC. Other factors such as where the tumor is located and your overall health are also considered. At Fred Hutch, we design your treatment plan around what will be most effective for you.

Fred Hutch offers all standard treatments for MCC. Our patients also have access to treatment options that may only be available through a clinical trial.