gms | German Medical Science

Introduction: Merkel`s cell carcinomas (MCC) are rare, highly malignant, neuroendocrine skin tumors of the elder age with a primary manifestation on the sun-exposed skin of the head. MCC are prone to regional and systemic metastatic spread as well as local recurrence. Radical excision plus radiotherapy due to a high sensitivity for irradiation is decisive for the therapeutic outcome. Especially with disseminated disease a functionally preserving approach is to be considered.

Method: A 85-year-old female presented with a lesion of the left parotid region. At the same time skin tumors of the lower eye lid were observed. The left facial nerve showed a paralysis House-Brackmann-grade II. History-taking revealed excision of a MCC 1½ year prior to presentation as well as resection and radiotherapy of a malignant melanoma of the left cheek 25 years ago. Cytological examination of the parotid tumor detected the cellular picture of a MCC metastasis.

Results: Facing the age of the patient a therapy aiming for functional preservation was performed. The metastasis could be removed by lateral parotidectomy, the skin metastasis by excision with full-skin-graft coverage. Subsequent radiotherapy seemed not to be advisable because of a massive local skin atrophy after previous irradiation.

Conclusion: This case clearly indicates the necessity for diagnostic accuracy and individual therapeutic management. Only radical tumor resection and complete cervikal lymphnodectomy combined with radiotherapy in the initial manifestation of MCC will provide chances for long-term survival. The treatment of a metastasized MCC can merely reach palliatve results, though it might be of considerable value concerning the control of the disease`s progress.