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Patients with stage I or II disease have a 5-year disease specific survival of 78% while those with stage III disease have only a 54%.1The 5-year overall survival (OS) for patients with metastatic disease has historically averaged between 0% to 18%.2-5There is a higher incidence of MCC in men and it predominantly affects those with lighter skin. Although it is still too early for long- term survival data, the information available demonstrates that these responses are more durable than those obtained with chemotherapy. Patients with even localized disease have a high risk of recurrence and those who develop metastatic disease have had a poor overall survival. In a cohort of 219 prospectively followed patients, an increase in oncoprotein antibody titers were associated with an increase in disease recurrence. In recent years much has been learned about the roles that MCPyV and mutational burden play in the pathogenesis of the disease. The acronym AEIOU was developed to help identify clinical characteristics of lesions suggestive of MCC: asymptomatic, expanding rapidly, immune suppression, older than 50 years of age, and UV-exposed area in a fair-skinned individual.8 Traditionally, MCC is thought to arise from Merkel cells located in the basal layer of the dermis.

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