The exact causes of MCC are not known. Factors strongly associated with the development of MCC are:

• · Age over 65 years
• · Fair skin
• · History of extensive sun exposure
• · Chronic immune suppression (e.g., Stress, kidney or heart transplantation or HIV)

The best available information on characteristics of patients with MCC comes from a study of 1,034 patients done in Canada in 2005. The average (median) age of the patients with MCC was 74 years. The most common sites of involvement were head followed by arms (upper limb). At the time of diagnosis, half of the patients had disease localized to the skin, while the other half had MCC that was no longer confined to the skin.

Age & Merkel cell carcinoma

Sunlight & Merkel cell carcinoma

Immune function & Merkel cell carcinoma

Age & Merkel cell carcinoma

The number of MCC cases increases with advancing age. The average age for developing MCC is 74 years, with 75% of patients over the age of 65 years. The incidence of MCC (see graph below) is somewhat greater in men (squares) than in women (circles) for each age group. Thus, advancing age and male gender are risk factors for MCC.

Frequency of MCC by age & sex: men (square) & women (circle). Adapted from Agelli, 2003.

Sunlight & Merkel cell carcinoma

It is believed that ultraviolet radiation from the sun plays a significant role in the development of MCC (see schematic below). This cancer is found most commonly on sun exposed areas of the body (e.g., head, neck, arms) in older Caucasian individuals, who may also have other sun-induced skin cancers. There is more MCC in sunny climates as opposed to areas with less sun. Thus, a history of extensive sun exposure is a risk factor for MCC.

Immune function & Merkel cell carcinoma

MCC is associated with a profoundly weakened immune system, such as in patients with HIV, or in patients who have received an organ transplant who are on medications that suppress the immune system. The risk of developing MCC is increased 8-fold in HIV patients (Engles, 2002), and 10-fold in organ transplant patients (Penn, 1999). Long-term suppression of the immune system (for many years) appears to be a risk factor for MCC. It is sensible to eat well, exercise, and get plenty of sleep to promote your own immune health. We know of no other way to increase immune function beyond that of maintaining good health.

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