The Cancer that Killed Jimmy Buffett
By Laura Monoghan, PA-C
Jimmy Buffett, the songwriter known for “Margaritaville,” “Cheeseburger in Paradise,” along with many others, recently died after a 4-year battle with Merkel Cell Carcinoma (MCC). His untimely death has increased awareness of this rare but aggressive form of skin cancer, whose origins are the Merkel cell, a sensory receptor cell in the top layer of the skin.
Who is at risk for Merkel Cell Carcinoma?
According to the American Cancer Society, approximately 90% of cases occur in people over age 50, and incidence increases with age. It is slightly more common in men (60%), and significantly more common in Caucasians (95%). Interestingly, 80% of cases in North America are associated with a virus, the Merkel Cell Polyomavirus. This virus is very common and often cleared by a healthy immune system. However, several factors can increase the risk of developing MCC, including:
- Immunosuppression (including organ transplantation, chronic lymphocytic leukemia, HIV infection)
- Increased sun exposure
- PUVA therapy
What does this skin cancer look like?
MCC commonly presents as a fast-growing, painless red to purple nodule on sun-exposed skin. However, it can also present as a metastatic disease without evidence of a primary nodule. The most likely spots are on the head or neck. The area can grow quickly and is usually painless. Although more common in fair-skinned individuals, Black patients may also develop these tumors and they may occur on the legs. They may be mistaken for a cyst, insect bite, or pimple.
How is it diagnosed?
MCC is typically diagnosed by a biopsy. This involves numbing the skin and taking a small sample of tissue to send to the lab for testing. Imaging such as a CT, MRI, or PET scan, as well as a lymph node biopsy, may be ordered to look for evidence of metastasis.
How is it treated?
The primary nodule is typically removed surgically, followed by radiation therapy. Also utilized for some patients is immunotherapy, which helps boost the immune system’s defense against the cancer, and chemotherapy which limits the spread of cancer cells.
How to prevent Merkel Cell Carcinoma
- Use sunscreen of at least SPF 30 every day, re-apply every 2 hours, and after swimming or perspiring
- Wear a wide-brimmed hat, sunglasses, and sun-protective clothing with UPF of 50
- Limit outdoor activities or seek shade between 10 am and 4 pm
- Look for changes in your skin
If you have any concerns or notice any changes in your skin that persist for more than 6 weeks, make an appointment to be examined.
Sources:
Bolognia, Jean, L. et al. Dermatology. Available from: Elsevier eBooks+, (4th Edition). Elsevier – OHCE, 2017.
James, William, D. et al. Andrews’ Diseases of the Skin. Available from: Elsevier eBooks+, (13th Edition). Elsevier – OHCE, 2019.
The American Cancer Society medical and editorial content team. (n.d.). Key statistics for Merkel cell carcinoma. American Cancer Society. https://www.cancer.org/cancer/types/merkel-cell-skin-cancer/about/key-statistics.html