Case Report: The role of nodal staging in periocular Merkel cell carcinoma — lessons from three cases

Cancer research · Merkel cell carcinoma

Mercer cell carcinoma (MCC) is a rare, aggressive cutaneous neuroendocrine tumor that can present with isolated lymphadenopathy in the absence of a detectable primary skin lesion, known as MCC of unknown primary.

Merkel cell carcinoma (MCC) of the eyelid is a rare, aggressive cutaneous neuroendocrine malignancy. We report three patients with upper eyelid MCC managed at a single ophthalmology centre. Patients were aged 74, 78 and 65 years; two were female and one male. All underwent wide local excision and complex eyelid reconstruction using Cutler-Beard and adjunctive flap techniques. Outcomes differed substantially: the patient who underwent neither nodal staging nor adjuvant therapy developed parotid metastases within two months and died at 4.5 months. The two patients in whom nodal staging was performed remain disease‑free at 35 and 13 months, respectively, despite also not receiving adjuvant radiotherapy. These cases illustrate the diagnostic challenge of periocular MCC and are consistent with guideline recommendations for nodal staging, although a series of three patients cannot separate the effect of staging from that of performance status.

This case underscores the importance of including MCC in the differential diagnosis of rapidly enlarging cervical masses, particularly in older adults, even when no cutaneous lesion is identified, and highlights the need for early biopsy and immunohistochemical analysis for accurate diagnosis.

Evidence level: Klinikai vizsgálat. Formális klinikai vizsgálati eredmény.

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