Merkel cell carcinoma (MCC) is a rare and highly aggressive neuroendocrine malignancy of the skin. We report a case of MCC of the lower lip. An 85-year-old woman was referred to our hospital because of a tumor in her lower lip. An extraoral examination revealed a palpable soft tumor measuring 17 × 11mm. A malignant tumor was suspected, and a FDG-PET/CT was performed. Accumulation was observed in the lower lip, the first spinous process, the right side of the second vertebral body, the left seventh rib, and the right pubis. The lip was resected first, because it was considered to be a bone metastasis of non-Hodgkin's lymphoma, the treatment of which had been discontinued in the past. A pubic biopsy was performed after surgery and MCC with multiple bone metastases was diagnosed. The painful pubis and ischium were irradiated (30Gy/10fr) , and Avelumab and Denosumab administered. However, brain metastasis and irAE enteritis were observed, and the patient died of this disease one year and eight months after the initial diagnosis.
We report a case of lower gingival carcinoma undergoing vagus nerve stimulation (VNS) therapy for intractable epilepsy. The patient was a 65yearold man. He was referred to our hospital because of pain in the left mandibular gingiva. His medical history was secondary epilepsy due to sequelae of cerebral hemorrhage, which was difficult to control with drugs alone, therefore, he was treated with VNS therapy. The left mandibular gingiva had a surface papillary mass measuring 30×20mm. Based on biopsy and imaging examinations, a diagnosis of lower gingival carcinoma (SCC, T2N0M0) was made. Subsequently, he underwent a left mandibular segmentectomy and free fibular flap reconstruction, including left neck dissection (Level 1-2) . VNS was in the Level 3 area and was not exposed to the operative field. Because of VNS, he could not undergo an MRI or use of an electric scalpel. After the operation, we confirmed the validation of VNS with the manufacturer. Three implants were placed in the reconstructed bone 1 year and 1 month after the operation, and implant overdenture was performed. About 3 years have passed since the operation, and there is no evidence of recurrence or metastasis.
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