Merkel Cell Carcinoma of the Hand: A Case Report and Review of the Literature

Abstract

Background: Merkel cell carcinoma (MCC) is a relatively rare and aggressive cutaneous neuroendocrine malignancy characterized by high incidence of local recurrence, distant metastases, regional nodal metastases, and high mortality. Clinically, MCC presents as a persistent asymptomatic red/pink shaped nodule, usually smaller than 2 cm with nontender intracutaneous swelling, with rapidly growing localized disease with lymph node metastases preceding distant metastases. Because of its rare nature and the lack of comprehensive understanding of the disease, management of MCC has been controversial. Methods: An 87-year-old retired Caucasian male with a history of tobacco use, chronic sun exposure, and multiple squamous and basal cell carcinomas presented with a 1.8 × 1.3 cm red, nontender nodule on the dorsum of the proximal phalanx of the left long finger first noticed 6 months prior to presentation. Biopsy was consistent with MCC after which he was treated with wide local excision, full-thickness skin grafting, and sentinel lymphadenectomy (1/4 nodes positive) followed by adjuvant radiation therapy. Results: He recovered appropriately and was clinically and radiographically disease free at 2.5-year follow-up. Conclusion: Although it remains rare, MCC has increased in incidence over the last several decades and has a predilection to occur over sun exposed areas. Highly aggressive, it has a high incidence of regional and distant metastasis as well as local recurrence. As a result, it is important that practitioners involved in the care of skin and hand lesions be aware of this condition and the need for a multidisciplinary treatment approach.

Keywords: MCC; Merkel cell carcinoma; hand; neurocutaneous; radiation.

Figure 1.

Initial clinic presentation at (a) low magnification and (b) higher magnification review emphasizes the slightly raised and discolored area on the left long finger over the proximal phalanx.

Figure 2.

Intraoperative photographs demonstrating (a) full-thickness excision of the lesion with a wide 1 to 2 cm margin and (b) full-thickness skin graft closure of the wound.

Figure 3.

Follow-up at (a) 2 months demonstrating early wound healing with a small area of epidermolysis and (b) 6 months demonstrating final wound condition and excellent functional result.