Surgery for merkel cell cancer

Merkel cell cancer (also known as merkel cell carcinoma) can be surgically removed. This type of cancer rarely spreads through the body. If it does, the metastases usually occur in the lymph nodes, which will then have to be surgically removed as well.

If the cancer has spread to other parts of the body, we will have to determine whether surgery is still an option for you. You may benefit more from other treatment options, such as drugs.

Merkel cell surgery – what to expect?

Merkel cell carcinomas are usually removed under local anesthesia. This surgery does not require hospital admission. However, f your merkel cell carcinoma has spread to the lymph nodes and these have to be surgically removed as well, you will have to be admitted to the hospital. Some people will require a skin transplant in order to cover the wound. The removed tissue will be analyzed at the laboratory.

Effectiveness

Prospects for merkel cell carcinoma depend on the development and stage of the tumor.

Preoperative screening

Before your surgery, you will be invited to meet with your anesthesiologist at the outpatient clinic for a consultation and a brief examination to assess your overall shape and any potential particularities we will need to keep in mind. The consultation assistant will measure your heart rate and blood pressure and will inquire about your height and weight. If needed, we can take those measurements during the appointment.

This preoperative screening will take approximately 20 minutes and will form the base of your anesthesia. Your anesthesiologist will listen to your lungs and heart and inspect your mouth and throat in preparation of the breathing tube that will be placed during surgery. Your anesthesiologist will also ask you:

whether you have been under anesthesia before
whether you have any other conditions
whether you have taken cancer medicine before
whether you have had radiation treatment before
whether you have any allergies
whether you smoke
whether you drink alcohol
what kind of medication you take

Please inform your anesthesiologist of the type of medication and dose you take, and how often you take it. Your physician may want to run more tests before your surgery, such as: electrocardiogram (ECG), lung x-rays, a lung function test, or a blood test.

General or local anesthesia

Before your surgery you will be given general anesthesia, local anesthesia, or a combination of the two. General anesthesia means that you will be completely unconscious during surgery, whereas local anesthesia means that a part of your body will be numb and motionless.

General anesthesia

General anesthesia completely sedates your body. You will be given a cocktail of sleeping medicine, pain killers, and sometimes a muscle relaxant through IV. You will be unconscious within 30 seconds. You will be ventilated during the entire process.

If you are having major surgery, we will place a respiration tube in your throat. For smaller surgeries, a small cap in the back of the throat will suffice. We will closely monitor your heart rate, blood pressure, breathing, and temperature through our monitoring devices.

Local anesthesia

If you are given local anesthesia, you will be conscious during your surgery. Local anesthetics are usually administered through an epidural in the spine, and will temporarily numb all body parts underneath. We may place a tube to give you IV pain medication during and after surgery.

Your anesthesiologist will keep a close eye on your blood pressure, heart rate, breathing, and temperature in order to adapt the anesthesia if needed.

Most people undergoing major surgery will be given a mixture of general and local anesthetics.

Side-effects and complications

Merkel cell carcinoma surgery rarely causes complications. You may experience bleeding, or your wound may open up, or get infected. These complications are easy to treat.

In case your tumor has spread through the body, your surgery will be more invasive, which increases the risk of complications. The nature and severity of these complications varies.

After your surgery

Merkel cell carcinoma surgery does not require hospital admission. However, if your cancer has spread and your lymph nodes will need to be removed, you will be admitted for one or more days.

Before you leave the hospital, we will give you further wound care instructions and advice. We will also schedule regular screenings with you. During your first consultation, you will receive the results of the tissue analysis. Screenings will occur once every 3 months and will continue in decreasing frequency over a period of 5 to 10 years.

Your tumor may return. If it does, it usually appears on or under the skin. We will see and feel whether this is the case for you during your screening appointments. You can help us detect recurring cancer early. We will give you further instructions on how to do this. Treatment is possible as long as the disease is detected in a timely matter.