Merkel-Cell Carcinoma
An 84-year-old woman was referred to the dermatology department for evaluation of a rapidly enlarging nodule on her right hand that had developed over 1 month. She reported no trauma to the area and had no systemic symptoms, such as fever, night sweats, and weight loss. Physical examination revealed a painless, red, denuded nodule over the base of the fourth finger (Panel A). No other lesions were identified, and no lymphadenopathy was detected. Analysis of a specimen obtained on punch biopsy revealed nodular infiltration of the dermis (Panel B), and a diagnosis of Merkel-cell carcinoma was made. Merkel-cell carcinoma is an aggressive cutaneous neuroendocrine tumor that is associated with polyomavirus infection, immunosuppression, advanced age, and sun exposure. Patients typically present with enlarging red or pink nodules in sun-exposed areas. The patient underwent amputation of the finger, and because a biopsy specimen obtained from a sentinel lymph node was positive for malignant cells, axillary lymph-node dissection was performed. No evidence of recurrence was found on follow-up at 5 months.
