Remembering Jimmy Buffett: Understanding Merkel Cell Carcinoma

What was made public

Jimmy Buffett, the singer-songwriter whose "Margaritaville" became a way of life for millions of listeners, died on September 1, 2023, at the age of 76.

CNN reported that he had Merkel cell carcinoma, a rare skin cancer, and that according to his official website he had been living with it for four years.

That is the public record. Beyond what his family and representatives shared, his care was private, and this page does not speculate about it.

Almost nobody had heard of Merkel cell carcinoma before that week. That is the useful part of the story, so here is what it actually is.

The cells the cancer starts in

Merkel cells sit in the top layer of the skin, the epidermis, very close to the nerve endings that let you feel light touch. They are thought to be a kind of neuroendocrine cell, which is why the cancer is also called neuroendocrine carcinoma of the skin.

Merkel cell carcinoma forms when these cells grow out of control. NCI describes it as a very rare cancer that starts most often on skin exposed to the sun, especially the head and neck, and also on the arms, legs and trunk.

The American Cancer Society puts it at about 3,000 people a year in the United States.

There is also a virus in the picture. Merkel cell polyomavirus is found in nearly all tumors of this type. Almost everyone is infected with it in childhood without any symptoms, and the virus was only discovered in 2008.

Why it is taken seriously despite being rare

NCI is direct about the behavior. Merkel cell carcinoma tends to grow quickly and to spread at an early stage. It usually reaches nearby lymph nodes first, and from there can travel to distant skin, lungs, brain, bone or other organs.

Despite how rare it is, NCI states it is the second most common cause of skin cancer death after melanoma.

The American Cancer Society, drawing on SEER data for people diagnosed between 2015 and 2021, puts five-year relative survival at 79% when the cancer is still confined to the skin where it started, 66% once it has reached nearby structures or lymph nodes, and 31% once it has spread to distant parts of the body. Those are group statistics from past years of treatment. They describe a population, not any individual, and they are not a forecast for anyone.

What it looks like

This is the part worth memorizing, because it does not look like what people expect a skin cancer to look like.

NCI describes it as usually a single lump on sun-exposed skin that is:

• Fast-growing.
• Painless.
• Firm, and dome-shaped or raised.
• Red or violet in color.

Painless is the trap. Most people use pain as their filter for whether something matters, and this lump does not hurt. It can also be mistaken for a cyst or a spot, though CNN notes cysts are often painful while these usually are not.

It is also not a mole. Melanoma typically shows up as a dark, uneven spot, and the ABCDE checklist NCI describes for pigmented lesions covers asymmetry, border, color, diameter and evolution. Merkel cell carcinoma is a different shape of problem: a raised lump appearing where there was nothing.

When to get checked

Show a clinician any of these, without waiting to see whether it settles:

• A new lump on sun-exposed skin that has grown noticeably over weeks rather than months.
• A firm red or purple lump that does not hurt.
• Any spot that bleeds, crusts, or will not heal.
• A mole that is changing in size, shape or color.
• A new or changing spot anywhere, if your immune system is suppressed.

Speed matters more here than with most skin lesions, because this one grows fast. Weeks, not a wait-and-see year.

NCI lists the risk factors as heavy exposure to natural sunlight, artificial sources such as tanning beds or PUVA therapy for psoriasis, an immune system weakened by disease such as chronic lymphocytic leukemia or HIV, medicines that suppress the immune system after an organ transplant, a history of other cancers, and being older than 50, male, or White. It also notes the cancer can develop in people with no known risk factors.

Diagnosis is straightforward in principle: a full-body skin exam, including a check of the lymph nodes, followed by a skin biopsy so a pathologist can look at the tissue.

What this story cannot tell you

• Merkel cell carcinoma is not melanoma. Both are serious skin cancers, but they start in different cells and look different.
• It does not mean every new lump is cancer. Most are not.
• One person's course predicts nothing about anyone else's.
• Sun exposure is a risk factor, not a verdict on any individual case. No one can assign a cause in a particular person, and this page does not try to.
• Nothing here is medical advice about a spot on your own skin. That needs someone looking at it.

The habit that actually helps

The practical takeaways are unglamorous and they have not changed. Protect your skin from ultraviolet radiation. Skip tanning beds. Notice what is new.

If your immune system is suppressed, by medication or by illness, treat that as a reason for regular skin checks rather than occasional ones.

Our pages on sun safety and skin cancer prevention cover the practical side, and skin cancer screening explains what a skin check involves and its limits.

Sources

• What to know about Merkel cell carcinoma, Jimmy Buffett's rare cancer (CNN, September 2023)
• NCI: Merkel Cell Carcinoma Treatment (PDQ) — Patient Version
• NCI PDQ: Melanoma Treatment (Health Professional Version)
• American Cancer Society — Key Statistics for Merkel Cell Carcinoma
• American Cancer Society — Survival Rates for Merkel Cell Carcinoma

How this page was made

An AI-assisted editorial system helped prepare this page. No named medical reviewer has reviewed it unless one is listed.

Cancer Explained is published by the National Cancer Information Foundation. It is not medical advice and does not suggest a test or treatment.

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