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Unknown primary Merkel cell carcinoma with cutaneous spread
  1. João Vasco Barreira1,
  2. Margarida Moura Valejo Coelho2,
  3. Catarina Ribeiro3 and
  4. Mónica Semedo4
  1. 1 Medical Oncology, Hospital de Santo Antonio dos Capuchos, Lisboa, Portugal
  2. 2 Dermatology and Venereology, Centro Hospitalar de Lisboa Central, Lisboa, Lisboa, Portugal
  3. 3 Universidade de Coimbra Faculdade de Medicina, Coimbra, Coimbra, Portugal
  4. 4 Medical Oncology, Hospital Distrital De Santarem Epe, Santarem, Santarém, Portugal
  1. Correspondence to Dr João Vasco Barreira, joaovascobarreira{at}


The authors present the case of a woman in the seventh decade of life with medical history of: left nephrectomy for renal tuberculosis and non-Hodgkin’s lymphoma treated with chemotherapy (QT) and radiotherapy. She presented with a 2-month history of non-tender, left inguinal lymph node enlargement. Positron Emission Tomography (PET)CT —scanshowed hypermetabolic inguinal and retroperitoneal lymphadenopathies, no primary tumour. On the second dermatological examination a pink, 2 cm plaque on the anterior left knee was noted. The histopathological analysis revealed Merkel cell carcinoma. The patient underwent two lines of systemic QT, with life-threatening toxicities limiting treatment. Followed overwhelming disease progression with lymphoedema and numerous skin metastases in the left lower limb. The patient received palliative care until death. The rare incidence of such neoplasia and its uncommon clinical presentation justifies reporting this case and highlights the importance of multidisciplinary teams in the management of cancer patients.

  • oncology
  • skin cancer
  • dermatology
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  • JVB and MMVC contributed equally.

  • Contributors JVB and MMVC developed and took the lead in writing the manuscript. CR and MóS provided critical feedback and helped shape the manuscript. All authors agreed with the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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