Authors: Reagan Grey T. Reyes, MD; Krisinda Clare C. Dirn-Jarnora, MD, FPDS


Introduction: Merkel cell carcinoma (MCC) is an aggressive dermal tumor of neuroendocrine origin. It is a rare, highly malignant primary skin tumor, with approximately 2,000 cases reported. This malignancy poses a challenge to clinicians due to its rarity and poor prognosis.

Case Summary: This is a case of a 68- year old male with a 6 month history of a solitary nodule on the right posterior forearm with no associated symptoms and with no relief from application of Tretinoin cream. With the gradual increase in size, the patient consulted with a Dermatologist who assessed him with Lipoma and advised excision biopsy, which on histopathology turned out to be MCC. Special stains down showed CK.20 positive, LCA (CD25) negative, NSE positive, and CK-PAN positive which are all consistent for MCC. PET Scan was also done which showed negative for any regional or distant metastases. Mohs micrographic surgery with full thickness skin graft repair was done by a trained Dermatological Surgeon and sentinel lymph node biopsy was performed by a Nuclear medicine specialist.

Conclusion: MCC is an aggressive cutaneous malignancy whose diagnosis is often overlooked at the time of presentation. New staging recommendations, practice guidelines, and diagnostic coding are of considerable benefit to patient care, and a multidisciplinary approach is vital to optimize outcomes. The emerging role of apolyomavirus in this malignancy provides exciting insights into the etiology of this tumor, and Mohs micrographic surgery is one of the available therapeutic options that offer better cure rates, less recurrence, and improved quality of life.





merkel cell carcinoma, mohs micrographic surgery, sentinel lymph
node biopsy, full thickness skin graft repair



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