NCCN Guidelines® Insights - Merkel Cell Carcinoma, Version 1.2024

The NCCN Guidelines for Merkel Cell Carcinoma (MCC) provide recommendations for diagnostic workup, clinical stage, and treatment options for patients. The panel meets annually to discuss updates to the guidelines based on comments from expert review from panel members, institutional review, as well as submissions from within NCCN and external organizations. These NCCN Guidelines Insights focus on the introduction of a new page for locally advanced disease in the setting of clinical node negative status, entitled “Clinical N0 Disease, Locally Advanced MCC.” This new algorithm page addresses locally advanced disease, and the panel clarifies the meaning behind the term “nonsurgical” by further defining locally advanced disease. In addition, the guideline includes the management of in-transit disease and updates to the systemic therapy options.

Target Audience

This journal article is designed to meet the educational needs of oncologists, nurses, pharmacists, and other health care professionals who manage patients with cancer.

Learning Objectives

Upon completion of this activity, participants will be able to:

  • Integrate into professional practice the updates to NCCN Guidelines for Merkel Cell Carcinoma.
  • Describe the rationale behind the decision-making process for developing the NCCN Guidelines for Merkel Cell Carcinoma.
Additional information

This activity is supported by educational grants from AstraZeneca; Bristol Myers Squibb; Janssen Biotech, Inc., administered by Janssen Scientific Affairs, LLC; and Seagen. This activity is supported by a medical education grant from Exelixis, Inc. This activity is supported by an independent educational grant from Merck & Co., Inc., Rahway, NJ, USA.

Course summary
Available credit: 
  • 1.00 AAPA Category 1 CME credit
  • 1.00 ACPE contact hours
  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 ANCC contact hours
  • 1.00 Participation
Course opens: 
Course expires: 

NCCN Continuing Education Disclosure Policy
It is the policy of NCCN that all planners, faculty, moderators, authors, reviewers and anyone involved in the planning and delivery of NCCN continuing education activities are expected to disclose ALL financial relationships they have had in the past 24 months with ineligible companies. The ACCME Standards for Integrity and Independence require that individuals who refuse to provide this information will be disqualified from involvement in the planning and implementation of accredited continuing education presented by NCCN. NCCN identifies, mitigates and discloses to learners all relevant financial relationships.

In addition, all content has been reviewed to ensure education promotes safe, effective patient care and does not promote the products or services of an ineligible company. Content, including any presentation of therapeutic options, is fair, balanced, evidence-based, scientifically accurate, and free of commercial bias and marketing. 


Ineligible Company: An ineligible company is any entity whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients. 

Relevant Financial Relationships: Financial relationships of any dollar amount occurring within the past 24 months are defined as relevant if the educational content an individual can control is related to the business lines or products of an ineligible company. There is no minimum financial threshold. We ask for disclosure of ALL financial relationships with ineligible companies, regardless of the amount and regardless of the potential relevance of each relationship to the education.

Faculty Disclaimers  

All faculty for this continuing education activity are competent in the subject matter and qualified by experience, training, and/or preparation for the tasks and methods of delivery.

Faculty presentations may include discussion of off-label use. Faculty will disclose that the use in question is not currently approved by the FDA per the product labeling or marketing.

Individuals Who Provided Content Development and/or Authorship Assistance

The faculty listed below have no relevant financial relationship(s) with ineligible companies to disclose.

Rachel Blitzblau, MD, PhD, Panel Vice Chair
Carlo M. Contreras, MD, Panel Member
Kelly Harms, MD, PhD, Panel Member
Kelly Olino, MD, Panel Member
Beth McCullough, RN, BS, Guidelines Layout Specialist, NCCN
Sara Espinosa, PhD, Oncology Scientist/Medical Writer, NCCN

The faculty listed below have the following relevant financial relationship(s) with ineligible companies to disclose. All of the relevant financial relationships listed for these individuals have been mitigated.

Chrysalyne D. Schmults, MD, MS, Panel Chair, has disclosed receiving grant/research support from Castle Biosciences, Regeneron Pharmaceuticals, and sanofi-aventis U.S.; serving as an officer, director, or any other fiduciary role for Chronicle Medical Software; owning equity interest/stock options in Chronicle Medical Software; and having ownership/partnership/principle in Chronicle Medical Software.
Paul Nghiem, MD, PhD, Panel Member, has disclosed serving as a scientific advisor for EMD Serono; receiving grant/research support from EMD Serono; and serving as a consultant for EMD Serono.

View all of the conflicts of interest for the NCCN Guidelines panel 

NCCN Staff Disclosures

None of the other planners for this educational activity have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, reselling, or distributing healthcare products used by or on patients.

In support of improving patient care, National Comprehensive Cancer Network (NCCN) is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

NCCN designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

NCCN designates this educational activity for a maximum of 1.0 contact hour. 

NCCN designates this knowledge-based continuing education activity for 1.0 contact hour (0.1 CEUs) of continuing education credit. UAN: JA4008196-0000-24-002-H01-P

Physician Assistants
NCCN has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 1.0 AAPA Category 1 CME credit. Approval is valid until January 10, 2025. PAs should only claim credit commensurate with the extent of their participation.

Available Credit

  • 1.00 AAPA Category 1 CME credit
  • 1.00 ACPE contact hours
  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 ANCC contact hours
  • 1.00 Participation


Please login or register to take this course.

Required Hardware/software

To access this activity, users will need:

  • A device with an Internet connection
  • Adobe Reader or other PDF reader software for article and certificate viewing/printing