Bilateral Primary Merkel Cell Carcinoma of the Upper Lid Misdiagnosed as Basal Cell Carcinoma

Abstract

Merkel cell tumour is a rare primary malignant tumour of the skin that can affect the lids and periocular region. It has a high rate of recurrence and metastasis following surgical excision and an overall mortality rate of 20-33%. Clinically, it is difficult to distinguish from other malignancies and the diagnosis requires careful histological analysis and immunocytochemical staining. A case of Merkel cell tumour affecting the lids and originally misdiagnosed is presented. Correct diagnosis was made only after the appearance of a second Merkel cell tumour on the contralateral lid. The pathogenesis, clinical progression, histology and management of this difficult condition are reviewed.

Periocular Cutaneous Malignancies: A Review of the Literature

“…170,171 MCC tends to involve the upper eyelid and usually presents as a painless nodule with a purple-red hue. [173][174][175] The diagnosis of MCC is uncommon, so this malignancy tends to be misdiagnosed initially, with the differential diagnosis including chalazion, BCC, cyst, nodular angiosarcoma, and metastasis; with the correct diagnosis being made only after biopsy. [173][174][175] The diagnosis of MCC is uncommon, so this malignancy tends to be misdiagnosed initially, with the differential diagnosis including chalazion, BCC, cyst, nodular angiosarcoma, and metastasis; with the correct diagnosis being made only after biopsy.…”

“…166,172 Unusual presentations, including a multinodular conjunctival mass and a tumor with tarsal invasion, have been reported. 172,173,[176][177][178] Immunohistochemistry is often needed to diagnose MCC, which exhibits a characteristic perinuclear dot pattern with CK-20 and stains positive for neuron-specific enolase, chromogranin, and others. 172,173,[176][177][178] Immunohistochemistry is often needed to diagnose MCC, which exhibits a characteristic perinuclear dot pattern with CK-20 and stains positive for neuron-specific enolase, chromogranin, and others.…”

Distinction of 2 Different Primary Merkel Cell Carcinomas in 1 Patient by Merkel Cell Polyomavirus Genome Analysis

“…4,5 Notably, the frequency of multiple primary tumors might be underestimated, since they are not accepted as a clinical observation. Both possibilities, ie, a secondary primary tumor or a contralateral distant metastasis, are very rare events in MCC.…”

Multicolor microRNA FISH effectively differentiates tumor types

“…BCC and MCC frequently share overlapping histologic features and are typically differentiated from each other and similar appearing tumors on histologic grounds and/or using a panel of immunohistochemical stains (8)(9)(10). Although there is little specific need to optimize BCC and MCC diagnostics, this unusual scenario was ideal for our proof-of-concept study.…”