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Expression of CXCR4, E-Cadherin, Bcl-2, and Survivin in Merkel Cell Carcinoma: An Immunohistochemical Study Using a Tissue Microarray

Knapp, Charles F. MD*; Sayegh, Zena MD; Schell, Michael J. PhD; Rawal, Bhupendra MS; Ochoa, Tatiana MD; Sondak, Vernon K. MD; Messina, Jane L. MD

The American Journal of Dermatopathology: August 2012 - Volume 34 - Issue 6 - p 592–596
doi: 10.1097/DAD.0b013e31823e25d3
Original Study

Abstract: Merkel cell carcinoma (MCC) is a rare but highly aggressive cutaneous malignancy with a mortality rate exceeding that of melanoma. Although smaller studies of markers of progression have been performed, large-scale investigation has been difficult due to the rarity of this tumor. Investigation of 4 potential immunohistochemical progression markers using an MCC tissue microarray was performed. An immunohistochemical analysis of CXCR4, E-cadherin, Bcl-2, and Survivin was performed on a tissue microarray of two hundred twenty-seven 0.6-mm tumor cores—110 primary, 73 local/regional metastatic, and 44 distant metastatic—from 87 patients, 23 of which were sampled 2 or more times. There was a statistically significant increase in immunoreactivity to CXCR4 and Survivin in local/regional nodal MCC metastases compared with primary and distant metastatic lesions. No significant differences by disease location were found for either Bcl-2 or E-cadherin. These results suggest a potential role for CXCR4 and Survivin in MCC tumor progression. However, previous data from other studies suggesting a role for Bcl-2 and E-cadherin in MCC progression are not confirmed in this larger sample. Further discovery of additional markers are needed to better characterize this rare but deadly malignancy.

*Department of Dermatology, University of South Florida College of Medicine, Tampa, FL

H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL

Department of Pathology and Cell Biology, University of South Florida College of Medicine, Tampa, FL.

The authors declare no conflicts of interest.

Reprints: Charles F. Knapp, MD, 12901 Bruce B Downs Boulevard, MDC 79, Tampa, FL 33612-4272 (e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.