Pedunculated and Telangiectatic Merkel Cell Carcinoma: An Unusual Clinical Presentation
A 70-year-old woman was referred to our department for evaluation of an asymptomatic skin neoformation on the right side of the neck. The lesion appeared about two months earlier and since then it increased rapidly in size. Physical examination revealed a reddish, firm-elastic, pedunculated lesion with a translucent and telangiectasic surface. The larger diameter of the tumor was 18 mm, while the stalk diameter was 12 mm [Figures and ]. No other significant skin or mucosal lesions were seen and no lymphadenopathy was present. The nodule was excised and submitted to histological examination, which showed uniform round cells with scant cytoplasm in the dermis []. Immunostaining with cytokeratin 20 highlighted a perinuclear dot-like positivity of cells []. Furthermore, the cells were chromogranin A, synaptophysin, somatostatin and CD56 positive []. On the basis of the clinical, histological and immunochemical data, we made a diagnosis of MCC. Sonography of locoregional lymph nodes and abdomen as well as a chest X-ray were negative. In accordance with the current guidelines,[] a wide excision of the residual surgical scar was performed with margins of 2 cm and the consequent surgical defect was reconstructed with a skin graft taken from anterior surface of the right thigh. Subsequently, sentinel lymph node biopsy was executed, with a negative result. Considering that the tumor presented with only skin involvement, we decided not to perform any further treatment. During a 6-month follow-up, no local or distant recurrence was reported. Anyhow, considering the high rate of recurrence of MCC,[] we recommended to the patient to continue a constant follow up.