Vitamin D deficiency is associated with greater tumor size and poorer outcome in Merkel cell carcinoma patients

J Eur Acad Dermatol Venereol. 2014 Mar;28(3):298-308. doi: 10.1111/jdv.12101. Epub 2013 Feb 1.


Background: Merkel cell polyomavirus has been recognized to be associated with Merkel cell carcinoma (MCC), but the evolution of this cancer probably depends on various factors. Vitamin D deficiency, defined by serum 25-hydroxyvitamin D levels <50 nmol/L, seems to influence cancer behavior and progression, but has never been assessed in MCC patients.

Objectives: First, to evaluate whether vitamin D deficiency was associated with tumor characteristics and prognosis in a cohort of MCC patients. Second, to assess expression of the vitamin D receptor (VDR) in MCC tumors.

Methods: Clinical findings, Merkel cell polyomavirus markers and vitamin D status were assessed in a cohort of French MCC patients. The study was limited to the 89 patients for whom the serum sample had been collected within 3 years after the diagnosis of MCC. Correlation between vitamin D deficiency and MCC characteristics and outcome were determined in regression analyses. VDR expression in MCC tumours was assessed by immunohistochemistry.

Results: Vitamin D deficiency was noted in 65.1% of the patients and was independently associated with greater tumor size at diagnosis (P = 0.006) and with metastasis recurrence (HR, 2.89; 95% CI, 1.03 to 8.13; P = 0.043), but not with death from MCC, although there was a trend (HR, 5.28; 95% CI, 0.75 to 36.96; P = 0.093). VDR was found to be strongly expressed in all 28 MCC tumor specimens investigated.

Conclusion: The association between vitamin D deficiency and MCC characteristics and outcome, together with detection of the VDR in MCC cells, suggest that vitamin D could influence the biology of MCC.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Merkel Cell / complications*
  • Carcinoma, Merkel Cell / pathology
  • Carcinoma, Merkel Cell / therapy
  • Cohort Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Receptors, Calcitriol / metabolism
  • Skin Neoplasms / complications*
  • Skin Neoplasms / pathology
  • Skin Neoplasms / therapy
  • Treatment Outcome
  • Vitamin D / blood
  • Vitamin D Deficiency / complications*
  • Vitamin D Deficiency / metabolism
  • Vitamin D Deficiency / pathology


  • Receptors, Calcitriol
  • Vitamin D