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Case report
Bone marrow involvement with Merkel cell carcinoma
  1. Ahmad Khan1,
  2. Shahroz Adil2,
  3. Oscar C Estalilla3 and
  4. Steven Jubelirer3
  1. 1West Virginia University Robert C Byrd Health Sciences Center Charleston Division, Charleston, West Virginia, USA
  2. 2Mercy Health Saint Mary's, Grand Rapids, Michigan, USA
  3. 3Charleston Area Medical Center, Charleston, West Virginia, USA
  1. Correspondence to Dr Ahmad Khan; drahmadk83{at}


Merkel cell carcinoma (MCC) is a rare but highly aggressive cutaneous tumour. Most tumours occur in the head and neck, extremities or torso and 36% of them involve the face. Bone marrow involvement in MCC is rare and to our knowledge only nine cases reported in the English literature. Bone marrow biopsy is not usually performed to stage MCC; thus, the true incidence of bone marrow involvement may be under-reported. The majority of the cases reported in the literature have some form of immunosuppression, which suggests a strong association. We report a case of extensive bone marrow involvement from MCC in an 80-year-old Caucasian woman with a history of rheumatoid arthritis treated with adalimumab, methotrexate and prednisone. It may be prudent to include bone marrow biopsy in the staging of MCC in immune-compromised patients.

  • skin cancer
  • carcinogenesis

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  • Contributors AK and SA have contributed significantly to writing the draft. OCE and SJ have proofread and helped with the technical aspects 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.

  • Patient consent for publication Not required.

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