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Interesting case of an abdominal wall Merkel cell carcinoma highlighting the importance of developing an Australian clinical practice guideline
  1. Anthony-Joe Nassour1,2,
  2. Darius Ashrafi3,4,
  3. Kevin Lah5 and
  4. Suntharalingham Sivananthan6
  1. 1Endocrine Surgery, Royal North Shore Hospital School, Saint Leonards, New South Wales, Australia
  2. 2Urology, Royal North Shore Hospital, Saint Leonards, New South Wales, Australia
  3. 3Department of Surgery, Sunshine Coast Hospital and Health Service, Nambour, Queensland, Australia
  4. 4PA Southside Clinical School, University of Queensland School of Medicine, Herston, Queensland, Australia
  5. 5General Surgery, Royal Brisbane and Woman's Hospital Health Service District, Herston, Queensland, Australia
  6. 6General Surgery, Hervey Bay Hospital, Pialba, Queensland, Australia
  1. Correspondence to Dr Anthony-Joe Nassour; anthonyjnas{at}


A 66-year-old Australian male farmer was referred for management of an asymptomatic, rapidly expanding, anterior abdominal wall mass. It was firm and well circumscribed. There were no overlying skin changes, constitutional symptoms or weight loss. His medical history included small bowel obstruction and resection from a Meckel’s diverticulitis and a 40-pack-year smoking history. Core biopsy was suggestive of a neuroendocrine tumour and Gallium-68-Dodecane-Tetraacetic-Acid (68GaTate) positron emission tomography revealed an avid solitary lesion confined to the subcutaneous space in the left anterior abdominal wall. Wide local excision was performed, and histopathology revealed Merkel cell carcinoma (MCC). Although classically regarded as a primary cutaneous neuroendocrine tumour, MCC may originate from the subcutaneous fat without obvious skin involvement. Older patients with asymptomatic, rapidly enlarging lesions, particularly if immunosuppressed, with significant ultraviolet sunlight exposure, should raise a high index of suspicion for MCC. Like melanoma, non-metastatic MCC should be treated aggressively for best prognosis.

  • dermatology
  • surgical diagnostic tests
  • general surgery
  • plastic and reconstructive surgery
  • surgical oncology

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  • Contributors All authors contributed equally to the creation of this case report. A-JN contributed significantly to the creation of the first draft of this case report. DA contributed to the literature review on practice guideline and revision of the final draft. KL contributed to the discussion of pathophysiology, pertinent imaging and revision of the final draft. SS contributed to the surgery itself and provided learning points as well as revision of the final draft.

  • 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 Obtained.

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

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