Merkel cell carcinoma of the upper extremity

Abstract

Merkel cell carcinoma is a rare, aggressive skin cancer which is usually characterized by lymph node involvement, distant metastases, and disease relapse. It is commonly seen in elder people and it affects the head, neck, and extremities. It can be difficult to differentiate macroscopically Merkel cell carcinoma from other small cells neoplasms. Herein is the case of a 66-year-old male patient, admitted in our department for a local recurrence of Merkel cell carcinoma on the posterolateral side of the proximal third right forearm. The surgical treatment included wide local excision with 2 cm safety margins, sentinel lymph node biopsy and grafting the residual defect using split-thickness skin. Postoperative no local or general complications were encountered. The final histological examination revealed Merkel cell carcinoma with all the excisional margins free of tumor and two positive sentinel lymph nodes. The patient has performed postoperative radiotherapy with monthly clinical examination. Six months after the last surgery and after undergoing radiotherapy, there were no local or distant signs of recurrence. Due to high rates of recurrence, close surveillance is demanded.