*Konrad Wroński1, Zbigniew Masłowski2, Przemysław Stefaniak2, Leszek Frąckowiak3
Treatment Merkel cell carcinoma of the facial skin – case report
1Department of Oncology, Faculty of Medicine, University of Warmia and Mazury, Olsztyn, Poland
Head of Department: prof. Sergiusz Nawrocki, MD, PhD
2Department of Surgical Oncology, Hospital Ministry of Internal Affairs with Warmia and Mazury Oncology Centre, Olsztyn, Poland
Head of Department: Andrzej Lachowski, MD
3Department of Public Health and Epidemiology, University of Warmia and Mazury, Olsztyn, Poland
Head of Department: prof. Anna Abramczyk, MD, PhD
Merkel cell carcinoma (MCC) is a rare neuroendocrine malignancy of the skin. It is highly aggressive skin cancer which is observed in patients older than 50 years (more than 95%). Merkel cell carcinoma was first time described by Toker in 1972. Merkel cell carcinoma often presents a rapid growth, reddish-blue dermal papule and can be asymptomatic. Surgery and radiotherapy are the most important in treatment Merkel cell carcinoma. Up to 48% of Merkel cell carcinomas are located in the head and neck region. Recommendations for surgery are based on the clinical size of the primary tumor. Excision margins for tumors < 2 cm should be 1 cm, and for tumors > 2 cm the margins should be 2 cm. Sentinel lymph node biopsy is recommended for all untreated primary tumors at the time of wide local excision. SLN biopsy is important in the staging and prognosis of Merkel cell carcinoma. In this article the authors presented a case of a 60-year-old man, Caucasian race, who was admitted to the hospital because of Merkel cell carcinoma of the facial skin. The patient underwent wide excision of the tumor and in the sixth day after surgery was discharged home.
Merkel cell carcinoma (MCC) is a rare neuroendocrine malignancy of the skin (1, 2). It is highly aggressive skin cancer which is observed in patients older than 50 years (more than 95%) (1, 3). The cell of origin was first time described in 1875 by Friedrich Merkel as epithelial in derivation with neuroendocrine differentiation (3). Merkel cell carcinoma was first time described by Toker in 1972 (3). Merkel cell carcinoma often presents a rapid growth, reddish-blue dermal papule and can be asymptomatic. Surgery and radiotherapy are the most important in treatment Merkel cell carcinoma (1, 2).
A 60-year-old man, Caucasian race, was admitted to the Department of Surgical Oncology because of Merkel cell carcinoma of the facial skin (fig. 1 and 2). In an interview with the patient, he informed us that the tumor of the facial skin was observed six months earlier and gradually expanded. The patient reported pain in the area of the tumor. Surgical biopsy showed Merkel cell carcinoma.
Fig. 1. Merkel cell carcinoma of the facial skin.
Fig. 2. Bleeding Merkel cell carcinoma of the facial skin.
He had no any other symptoms, there was no history of weight loss and loss of appetite. The patient was not treated chronically diseases. He had no surgeries before and there was no history of carcinoma in patient family. Blood test and other routine hematological examinations and biochemical tests were within normal limits.
On physical examination, there was bleeding tumor size 55 x 65 millimeters. Regional lymph nodes were not enlarged. The patient was qualified for surgery. In general anesthesia has been wide tumor resection of the right temporal area with adequate free margins and free graft skin was taken from the supraclavicular region. The tumor was collected for histopathological examination. Histopathological examination revealed Merkel cell carcinoma. The tumor was excised in its entirety. The duration of surgery was 65 minutes. Patient after surgery felt good and did not complain of pain. The postoperative period was uncomplicated and the patient left the ward in the sixth day after surgery. The patient is in the care of outpatient surgical oncology.
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