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The approval of avelumab and promising results seen in a clinical trial with pembrolizumab will dramatically shift the way patients are treated as part of standard of care.

In 2017 avelumab became the first immunotherapy to be approved for advanced stage MCC. MCC is a rare and aggressive malignancy. Intratumoral CD8 positivity may play an additional role in determining prognosis at diagnosis for this immunogenic malignancy. MCC typically affects older individuals with the mean age for diagnosis of 74 years for men and 76 years for women.6The risk of MCC is higher in immunosuppressed individuals such as those with a history of organ transplant HIV or other malignancy.
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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