诊断
用于诊断梅克尔细胞癌的检查和程序包括：
- 体格检查。医生会检查您的皮肤是否有异常的痣、雀斑、色素斑点和其他生长物。
- 采集可疑皮肤样本。在皮肤活检过程中，医生会从您的皮肤中取出肿瘤或肿瘤样本。在实验室中对样本进行分析，以寻找癌症体征。
确定范围
医生可能使用以下检测来帮助确定癌症是否已扩散到皮肤以外区域：
前哨淋巴结活检。前哨淋巴结活检旨在确定癌症是否已扩散到淋巴结的手术。此手术需要在癌附近注射一种染料。染料随后会通过淋巴系统流到淋巴结。
第一个浸入染料的淋巴结被称为前哨淋巴结。医生会切除这些淋巴结，然后在显微镜下寻找癌变细胞。
影像学检查。医生可能建议给胸部和腹部做一次胸部 X 线检查和电子计算机断层扫描（CT），以帮助确定癌症是否已扩散到其他器官。
医生也可能考虑其他影像学检测，如正电子发射断层成像（PET）或奥曲肽显像（通过注射放射性示踪剂来检查癌细胞扩散情况的检测）。
Biopsy
A biopsy is a procedure to remove a sample of tissue for testing in a lab. For Merkel cell carcinoma, a healthcare professional may use a tool to cut away some of the concerning skin. Other ways to do a skin biopsy involve using a shaving tool or a circular cutting tool to get some of the skin. The sample is tested in a lab to see if it is cancer.
Tests for cancer that spreads
Your healthcare professional may use other tests to find out whether the cancer has spread beyond your skin. These other tests may include:
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Sentinel node biopsy. A sentinel node biopsy is a procedure to see whether cancer has spread to the lymph nodes. This procedure involves putting a dye into the skin near the cancer. The dye then flows through the lymphatic system to the lymph nodes.
The first lymph nodes that get the dye are called the sentinel nodes. A healthcare professional removes these lymph nodes and looks for cancer cells under a microscope.
- Imaging tests. Imaging tests used to look for signs that the cancer has spread include a chest X-ray, a CT scan of the chest and belly, and a positron emission tomography scan, also called a PET scan.
治疗
梅克尔细胞癌的治疗方法包括：
外科手术。在手术过程中，医生会切除肿瘤以及肿瘤周围的正常皮肤边缘。如果有证据表明癌细胞已经扩散到皮肤肿瘤部位的淋巴结，还会切除这些淋巴结（淋巴结清扫）。
外科医生往往用手术刀切除癌细胞。在某些情况下，医生会采用一种叫做莫氏显微手术的手术。
在莫氏显微手术中，医生会逐层切除组织薄层，并在显微镜下进行分析，看看它们是否含有癌细胞。如果发现癌细胞，手术过程就会继续进行，直到在组织中看不到癌细胞。这种手术仅会切除较少的正常组织，既能减少瘢痕形成，又能确保皮肤边缘没有肿瘤。
放射疗法。放射疗法采用 X 线和质子等高能量束定向杀死癌细胞。在放疗过程中，您躺在手术台上，一台大型机器围绕您转动，引导放疗光束精确照射在您身上。
有时候会在术后使用放疗来消灭肿瘤切除后可能残留的癌细胞。
对于选择不做手术的患者，放疗也可以作为唯一的治疗方法。放疗也可以用于治疗癌症扩散的部位。
- 免疫疗法。免疫疗法会使用药物来帮助免疫系统对抗癌症。免疫疗法常用于治疗扩散到身体其他部位的梅克尔细胞癌。
化疗。化疗使用药物杀死癌细胞。化疗药物可以通过手臂静脉或药片方式给药，也可以同时通过这两种形式给药。
化疗并不是常用的治疗手段，但如果梅克尔细胞癌已经扩散到淋巴结或身体其他器官，或者在治疗后复发，医生可能会建议您化疗。
Surgery
A surgeon removes the cancer along with a border of skin that doesn't have cancer. For cancer that has spread to lymph nodes near the skin cancer, the surgeon removes those lymph nodes. This is called a lymph node dissection.
Surgery most often involves a scalpel to cut away the cancer. Sometimes, a surgeon may use a procedure called Mohs surgery.
Mohs surgery involves cutting away thin layers of skin. The surgeon uses a microscope to look at each layer for cancer. The process keeps going until there's no more cancer. The goal of Mohs surgery is to remove all the cancer without harming the healthy skin around it.
Radiation therapy
Radiation therapy treats cancer with powerful energy beams. For Merkel cell carcinoma, a healthcare professional may use radiation therapy after surgery to destroy cancer cells that remain. Radiation may be the only treatment for people who don't want to have surgery. Radiation also can treat cancer that has spread.
Immunotherapy
Immunotherapy for cancer is a treatment with medicine that helps the body's immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells.
Most often, immunotherapy treats Merkel cell carcinoma that comes back after treatment or spreads to other areas of the body.
Chemotherapy
Chemotherapy treats cancer with strong medicines. Healthcare professionals don't often use chemotherapy to treat Merkel cell carcinoma. But your healthcare team may suggest it if your Merkel cell carcinoma spreads to your lymph nodes or other organs, or if it returns after treatment.
临床试验
探索 Mayo Clinic 的研究 测试新的治疗、干预与检查方法，旨在预防、检测、治疗或控制这种疾病。
准备您的预约
如果您很担心皮肤上的痣、雀斑或肿块，请先与医生约诊。如果医生怀疑您可能患有皮肤癌，很可能将您转诊至皮肤专科。
由于就诊时间可能很短，而且往往有很多事情需要谈论，因此最好做好准备。以下信息可帮您做好准备，并了解医生可能会做什么。
您可以做什么
- 写下您目前出现的所有症状，包括那些看起来与您安排本次预约无关的任何症状。
- 写下关键的个人信息，包括任何主要压力或近期的生活变化。
- 列出您正在服用的所有药物、维生素或补充剂的清单。
- 考虑让家人或朋友陪同就诊。有时，您可能很难记住就诊时医务人员告知的所有信息。陪同您的亲友可能会记住您遗漏或忘记的信息。
- 写下要向医生咨询的问题。
由于就诊时间有限，请提前准备好问题清单以便充分利用就诊时间。请按照从最重要至最不重要的顺序列出问题，以免时间不够。对于梅克尔细胞癌，需要向医生咨询的一些基本问题包括：
- 我的症状和疾病可能是什么原因造成的？
- 我的症状或疾病还有其他可能的原因吗？
- 我需要做哪些检查？这些检查如何进行？
- 我有哪些治疗选择？
- 您将如何检查我对治疗的反应？
- 我的病情复发的可能性有多大？在这种情况下将采取哪种治疗方案？
- 我需要做哪些针对复发的随访检查？
- 我还有其他健康问题。我怎样才能同时管理好这些疾病？
- 有没有我需要遵守的任何限制？
- 我应该去看专科医生吗？治疗费用是多少，我的保险能报销吗？
- 有没有我可以带走的手册或其他印刷材料？您推荐哪些网站？
除了您准备咨询医生的问题外，在就诊期间，您可以随时提问。
Make a list of:
- Your symptoms and when they began. Include any that don't seem linked to the reason you made the appointment.
- Key personal information. Include major stresses or recent life changes.
- Medical information. Include other conditions you have or conditions that run in your family.
- All medicines, vitamins or supplements that you take. Include the dosages.
- Questions to ask your healthcare professional.
For Merkel cell carcinoma, questions might include:
- What is likely causing my symptoms or condition?
- Are there other possible causes for my symptoms or condition?
- What tests do I need?
- What treatments are there?
- I have other health conditions. How can I best manage them together?
- Are there brochures or other printed material I can have? What websites do you suggest?
Be sure to ask all the questions you have.
医生可能做些什么
您的医生可能会询问一些问题。准备好回答这些问题，可以让您预留时间讨论您更为关注的其他问题。医生可能会问到：
- 您第一次注意到您的症状是什么时候？
- 随着时间推移，您的症状发生了什么变化？
- 是否有任何因素似乎能令您的症状好转？
- 您是否经常待在阳光下，或者您使用过日光浴床吗？
- 您是否有其他皮肤病（例如皮肤癌或银屑病）史？目前为止针对这些疾病接受过什么治疗？
- 您是否曾被诊断患有免疫系统疾病？如果是，目前为止接受过什么治疗？
- 您是否被诊断患有其他疾病，或接受过相关治疗？
Dec. 06, 2022