According to Florida dermatologists, the skin cancer that killed Jimmy Buffett is becoming more common in the Sunshine State, and residents should be on the lookout for a few distinguishing characteristics.
While rare, aggressive skin cancer appears most frequently in sun-exposed skin areas such as the face, scalp, or neck. People with fair skin, over 50, and a history of sun exposure are more likely to develop Merkel cell carcinoma. The key to survival is to learn early and act quickly.
People diagnosed and treated for this type of skin cancer have a 75% five-year survival rate while it is still localized, but once it spreads to a distant organ, the survival rate drops to only 24%.
What to look for
Dermatologist Steven Hacker of Delray Beach says he has many patients with Merkel cell carcinoma who he is treating or following.
“It looks like a very non-specific bump that is flesh-colored or reddish blue in color and can be the size of an eraser tip on a pencil,” he explained. “A biopsy is required to make a diagnosis.” The sooner it is discovered, the better your chances.”
If something that looks like a pimple or a bug bite doesn’t go away, he recommends seeing a dermatologist. In some cases, the original bump spawns additional bumps nearby.
Merkel cell carcinoma is a dangerous cancer that can spread to other parts of the body. After melanoma, it is the second most common cause of skin cancer-related death.
“While it’s uncommon in the United States, we see a lot of it in Florida,” said Dr. Michael Kasper, director of radiation oncology at Lynn Cancer Institute, part of Baptist Health, at Boca Raton Regional Hospital. “We see it a couple of times per month.”
While it is more common in men, Kasper reports seeing it in women as well. “With the population living in Florida, one of the biggest things that sets us apart is the suppressed immune system that happens as we age.”
According to Kasper, the nodule beneath the skin’s surface in Merkel is hard or firm, but not painful. “It can grow quite quickly.” Doctors who don’t know what it is will sometimes try to drain it and nothing will come out,” he said. “It should not have been drained.” You wouldn’t drain it if you knew what you were looking at. Most of the time, if caught early and localized, it can be cured.”
According to Kasper, the majority of cases of the cancer may be caused by a virus called Merkel cell polyomavirus. It is still unknown how this virus causes Merkel cell carcinoma.
When a biopsy reveals Merkel cell carcinoma, doctors will remove the nodule but also use radiation to eliminate cancerous tissue and reduce the likelihood of recurrence. A biopsy of a nearby lymph node will also be performed, as well as a full body PET scan to determine whether the cancer has spread to organs. If the Merkel cell carcinoma has spread or is inoperable, oncologists recommend immunotherapy. The federal government approved a new immunotherapy for the treatment of advanced Merkel cell carcinoma in 2019.
Other skin cancers
Despite the fact that skin cancer is the most common cancer diagnosis in the United States, most Americans fail to get checked on a regular basis, according to a Prevent Cancer Foundation online survey of more than 2,000 people conducted in January. According to the survey, 70% of Americans aged 21 and up have not had a skin check in the previous year.
Basal cell carcinoma, squamous cell carcinoma, and melanoma are the three most common types of skin cancer. Anyone, regardless of skin color, can get these, but people with freckles, fair skin, and light hair are more likely to get them.
Basal cell carcinomas grow slowly and rarely spread to other parts of the body. However, if this cancer is not treated, the cells can spread deeper and penetrate nerves and bones. Squamous cell cancer is usually not fatal, but if left untreated, it can grow large and spread to other parts of the body. Melanoma is the most dangerous type of skin cancer because it is the most likely to grow and spread.
Merkel cell carcinoma is 40 times less common than melanoma. Buffett, the “Margaritaville” singer and legendary Florida beachgoer, had been suffering from it for four years.
There are about a dozen other rare types of skin cancer.
Bob Marley, the legendary Jamaican singer, musician, and songwriter, died at the age of 36 from a rare skin cancer. He had acral lentiginous melanoma, which showed up as a dark spot under his toe.ALM is the most common type of melanoma found in people of color and typically develops under nails, on the soles of the feet, or on the palms of the hands.
“If you have a spot that is evolving or changing rapidly over weeks or months, have it checked out,” said Dr. Charles Dunn, an ADCS Orlando Dermatology resident. “You can get skin cancer in areas that are not even exposed to the sun.”
“With all skin cancers, but especially with Merkel,” Dunn said, “time is of the essence.” Early detection, he claims, leads to better survival rates.
Be vigilant, get checked
Dr. Rajiv Nathoo, a dermatologist and complex clinic director for Advanced Dermatology and Cosmetic Surgery Clinics in Orlando, says there is a lot of misdiagnosis with skin cancer and recommends that Floridians get their skin checked with board-certified dermatologists on a regular basis. “While the general public should be aware of red flags and seek treatment, skin cancer is complex, which is why we exist as a field.” Nathoo stated that he has a patient in hospice with Merkel who was misdiagnosed and has now spread skin cancer. “It’s significant because of the mortality rates.” By the time Merkel is diagnosed, it has metastasized one-third of the time.”
Although genetics and the immune system play a role, dermatologists advise wearing sunscreen, avoiding sunburns, and staying indoors during the hottest times of the day. Furthermore, according to a report in Harvard Health Publishing, nicotinamide, a form of vitamin B3, has been shown to reduce the number of skin cancers when taken orally, but the benefits are lost once you stop taking it.
“Talk with your dermatologist to see if you are a candidate for Nicotinamide,” Hacker advised.
While dermatologists recommend annual skin checks, those over the age of 65 should consider doing so twice a year.
“Knowing what’s normal for you and your skin is really important,” said Heather Macky, senior director of cancer prevention and early detection at the Prevent Cancer Foundation. “If you notice a mole, freckle, or bump that is changing in size, shape, or color, notify your provider immediately.”