Merkel cell carcinoma (MCC) isMerkel cell carcinoma (MCC) is an uncommon malignant neoplasm of the skin with potentially aggressive biologic behavior. Histologic analysis of these tumors alone is a poor predictor of disease progression, and only clinical staging allows a prognostic assessment of the biologic behavior of this neoplasm. Although immunohistochemical and ultrastructural data show evidence of neuroendocrine differentiation, the histogenesis of this tumor remains controversial.1,2 It was suggested originally that MCCs are derived from neural crest cells.3 Other studies, however, favor an adnexal 4,5 or epidermal cell 4,6,7 origin, which acquires neuroendocrine features during malignant transformation.Cytogenetic and molecular studies have shown evidence for genetic changes on chromosome l p in different tumors with well-established neuroendocrine origins, specifically n e u r o b l a s t o m a s , 8 , 9 m a l i g n a n t