Merkel cell carcinoma (MCC) is a rare and aggressive skin cancer occurring in about 3 people per 1,000,000 members of the population. It is also known as cutaneous APUDoma, primary neuroendocrine carcinoma of the skin, primary small cell carcinoma of the skin, and trabecular carcinoma of the skin. Factors involved in the development of MCC include the Merkel cell polyomavirus (MCPyV or MCV), a weakened immune system, and exposure to ultraviolet radiation. Merkel-cell carcinoma usually arises on the head, neck, and extremities, as well as in the perianal region and on the eyelid. It is more common in people over 60 years old, Caucasian people, and males. MCC is less common in children. Signs and symptoms
Merkel cell carcinoma (MCC) usually presents as a firm nodule (up to 2 cm diameter) or mass (>2 cm diameter). These flesh-colored, red, or blue tumors typically vary in size from 0.5 cm (less than one-quarter of an inch) to more than 5 cm (2 inches) in diameter and may enlarge rapidly. Tumors can present as painless, tender or itchy, and other MCC manifestations as papules or plaques have also been reported. Although MCC may arise almost anywhere on the body, it is most commonly found in sun-exposed areas such as the head, neck or extremities. Five key attributes of MCC were summarized in 2008 in the acronym AEIOU (Asymptomatic/lack of tenderness, Expanding rapidly, Immune suppression, Older than 50 years, and Ultraviolet-exposed site on a person with fair skin). Ninety percent of MCCs have three or more of those features.
Losartan/hydrochlorothiazide, sold under the brand name Hyzaar among others, is a combination medication used to treat high blood pressure when losartan is not sufficient. It consists of losartan (an angiotensin II receptor antagonist) and hydrochlorothiazide (a diuretic). It is taken by mouth.Common side effects include dizziness, back pain, and upper respiratory tract infections. Serious side effects may include low blood pressure, kidney problems, allergic reactions, and electrolyte problems. Use in pregnancy and breastfeeding is not recommended. Losartan works by blocking the effects of angiotensin II while hydrochlorothiazide works by decreasing the ability of the kidneys to absorb electrolytes. Interactions include with lithium, agents which increase potassium, and NSAIDs.The combination was approved for medical use in the United States in 1995. It is available as a generic medication. In 2019, it was the 73rd most commonly prescribed medication in the United States, with more than 10 million prescriptions. Medical uses
It is used for high blood pressure (hypertension) once a day. Based on the initial blood pressure response and/or losartan-hydrochlorothiazide side effects, the dosage may be increased or decreased. With each change in dosage, it may take up to a month to see the full effect. Side Effects
Common side effects include dizziness, headache, back pain, rash, fever, diarrhea, cough, and upper respiratory tract infections. Serious side effects may include low blood pressure, kidney problems, allergic reactions, and electrolyte problems. Drug interactions
Drug interactions to be aware of include lithium, agents increasing serum levels of potassium, and the use of hydrochlorothiazide with antidiabetic drugs both oral agents and insulin.