An unusual presentation of Merkel cell carcinoma: a case report

Merkel Cell Carcinoma Mimicking a Pyogenic Granuloma on the Thumb

Merkel cell carcinoma (MCC) is a rare and aggressive skin cancer that can present with various clinical manifestations. An 80-year-old male, known to have chronic lymphocytic leukaemia presented with a lesion on his left thumb, initially thought to be a pyogenic granuloma. The lesion was cauterized with silver nitrate but remained persistent. A curettage biopsy was performed, and a histopathological examination revealed MCC. The patient was subsequently referred to dermatology and plastic surgery for further management. The lesion was excised; a full-thickness skin graft was used to close the defect. This case highlights the importance of considering MCC in the differential diagnosis of skin lesions, even if they present with a benign appearance.

Primary Merkel Cell Carcinoma: A Retrospective Analysis of 31 Cases in Poland

Introduction

Merkel cell carcinoma (MCC) is a rare, aggressive cutaneous neuroendocrine cancer that typically arises in sun-exposed areas of the skin, especially in the elderly. Significant advances have recently been made regarding skin cancers, but data on cases of MCC are rather limited as these patients are frequently grouped together with other non-melanoma skin cancers (NMSC). Here, we performed an analysis of the clinical profile of patients with MCC in Poland to identify major factors influencing the prognosis.

Methods

Approximately 13,000 pathology and medical records were examined to identify patients with MCC diagnosed between 2010 and 2019. The management and outcomes of patients with histologically confirmed MCC were retrospectively evaluated.

Results

Thirty-one patients diagnosed with MCC were identified. The tumor occurred predominantly in women (61.3%) and in the elderly (mean 75.6 years). Twenty-nine patients had locoregional MCC and two had metastatic MCC at the time of diagnosis. Patients in stage I disease had excellent prognosis. In stages II and III, respectively 22.2% and 50.0% of patients developed metastases. Among patients who received chemotherapy with cisplatin and etoposide, 17% achieved partial remission with progression-free survival (PFS) of 8.0 months, and a further 50% achieved stable disease with PFS of 4.0, 4.5, and 4.5 months respectively. In 6 (19.4%) patients MCC coexisted with chronic lymphocytic leukemia (CLL). In all six cases CLL preceded MCC development.

Conclusions

Female gender, tumor-free resection margins, and local disease were found to be independent prognostic factors in MCC progression. Patients with hematological malignancies, immunosuppression, and those with immune deficiencies should be closely followed up as they are predisposed to develop MCC.

Electronic supplementary material

The online version of this article (10.1007/s13555-020-00424-5) contains supplementary material, which is available to authorized users.

Merkel cell carcinoma: a case report and literature review

Merkel cell carcinoma (MCC) is an aggressive cutaneous malignancy of neuroendocrine origin presenting as a painless, rapidly growing nodule. MCC often presents in elderly, fair-skinned individuals in sun-exposed areas. Diagnosis is often overlooked at time of presentation due to its rarity, but MCC is twice as deadly as malignant melanoma. There has been bigger interest in the disease due to increasing incidence and an association with the prevalent virus Merkel cell polyomavirus. This study describes an uncommon presentation of MCC as a right gluteal lesion in an Afro-Panamanian patient. The tumor was suspected to be fibrolipoma, but Immunohistochemistry revealed the diagnosis of MCC, as stains for CD56 and CK20 were positive. In addition to surgical excision, the patient was referred for adjuvant radiotherapy. This case report and literature review elucidates the clinical, histopathologic and management aspects of MCC, which will help in recognizing and treating these tumors.