JMIR Publications

ABSTRACT

Background:

Merkel cell carcinoma (MCC) is a rare primary neuroendocrine skin tumor that represents as flesh-colored or bluish-red nodule on the face, neck, or head. Long-term Ultraviolet (UV) radiation exposure and Merkel cell polyomavirus (MCV) are associated with Merkel cell carcinoma pathogenesis. The incidence of MCC has been increasing over the past few decades; however, the incidence of Merkel cell carcinoma in the cheeks is not well-documented in the literature. Therefore, we present a case of Merkel cell carcinoma in an 87-year-old male in the right cheek.

Objective:

The primary goal of presenting the case was to bring Merkel cell carcinoma, which is a diagnostic challenge, to the notice of dermatologists and oncologists, as early detection and prompt treatment are important. Case Report: The patient is 87 years old and has a significant past medical history of diabetes mellitus, hypertension, dyslipidemia, chronic kidney disease stage 3, benign prostatic hyperplasia, chronic hyponatremia, acute pancreatitis, essential thrombocytosis on hydroxyurea, and ischemic heart disease. Now, the patient presented with a mildly swollen right upper lip showing a poorly defined, relatively homogenous subcutaneous lesion with a history of persistence for 1.5 months. The clinical examination revealed a 5x3 cm nodular lesion on the right side of the cheek with swelling of the right upper lip. Induration and nodules were felt upon palpation of the lesion. All other systems were reviewed and were negative. Lab results revealed that WBC count, platelets count, and creatinine were high; hemoglobin and hematocrit were low. A skin punch biopsy revealed skin with diffusely infiltrative tumor within the dermis. Additionally, TTF-1 was negative, and CK20 was positive in the tumor cell. Ki67 showed a high proliferative index. Immunohistochemistry markers results and histopathological features confirmed the diagnosis of Merkel cell carcinoma. The patient was referred to the oncology department for further management. Conclusion: Merkel cell carcinoma of the skin is an aggressive lesion with a high risk of metastasis and recurrence, which is more common in immunocompromised people. Prompt management and treatment of Merkel cell carcinoma is essential because if left untreated, it can spread to other parts of the body and can also metastasize to lymph nodes and other organs.