%0 Journal Article
%T Secondary Merkel Cell Carcinoma Manifested in the Parotid
%A M. Basati
%A K. Kassam
%A A. Messiha
%J Case Reports in Dermatological Medicine
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/960140
%X Background. Merkel cell carcinoma of the head and neck is a rare and aggressive malignant tumour. Both the dermatological and surgical colleagues should be aware of this entity as lesions usually present on sun exposed areas of the skin such as the head and neck. Main Observation and Treatment. A 69-year-old male originally presented to the maxillofacial surgery department with a growing lesion on the left eyebrow. Histological analysis confirmed Merkel cell carcinoma and consequently surgical excision was carried out. A follow-up PET/CT scan 2 years later demonstrated a hotspot in the left parotid gland. Fine needle aspiration and cytology revealed Merkel cell carcinoma. A subtotal parotidectomy left side with ipsilateral selective neck dissection levels I to III was carried out. Conclusions. Potential secondary Merkel cell carcinoma in the head and neck region should be taken into account when planning short- and long-term follow up for previously diagnosed patients. This followup should involve both dermatological and surgical colleagues. 1. Introduction Merkel cell carcinoma (MCC) is a rare and aggressive malignant tumour of neuroendocrine origin, with incidence being reported as low as 0.44/100£¿000 cases a year [1]. Clinical diagnosis is difficult due to a nonspecific appearance. Often the lesion presents as a nonindurated and slightly erythematous nodule. The most common location of the lesion is on sun exposed areas of the skin, with UVB radiation posing an increased risk [2]. Epidemiological studies reveal further risk in immunocompromised patients and Caucasian patients older than 50 [3]. Furthermore 48% of lesions are diagnosed in the head and neck region, with 61% of patients being male [4]. Heath et al. [3] use a favourable acronym when looking at typical clinical features at presentation: AEIOU, asymptomatic, enlarging rapidly, immunosuppression, older age, and UV exposed site. MCC has a poor 5-year prognosis, with a 75% survival for local disease and 50% for regional [5]. The prognosis is even poorer for: (1) male patients, (2) primaries of T2 size and extension, (3) nodal involvement, (4) and if metastatic disease is present [4]. The frequency of both local and regional spread of disease is high, with up to 21% of cases developing distant metastatic lesions [6]. Common sites of metastasis have been described as lymph nodes, mediastinum, lung, liver, and bone [7]. The mortality rate of MCC is twice that of melanoma [8]. Even with this aggressive nature of the disease and high risk of mortality, the awareness of MCC is poor amongst
%U http://www.hindawi.com/journals/cridm/2013/960140/