Case history
Case history #1
An 80-year-old white man who continues to work as a farmer presents with a rapidly growing lesion on the left forearm. Past medical history is significant for immunosuppression due to kidney transplant. Examination reveals a 2 cm pink papulo-nodule on the left forearm. There is no associated pain, itching, or bleeding. Skin biopsy confirms MCC, and Merkel cell polyomavirus (MCPyV) immunohistochemistry is negative. Physical exam reveals palpable lymphadenopathy in the left axilla. Fine-needle biopsy demonstrates metastatic MCC to the axillary lymph node basin. Staging imaging reveals no distant disease.
Case history #2
A 75-year-old black man presents with a long-standing history of an asymptomatic 5 cm subcutaneous mass on the buttock. On examination, there are no overlying skin changes and the lesion is not tender to the touch. Skin biopsy confirms MCC, and MCPyV serology is positive. Physical exam reveals no clinical adenopathy in the groin. Staging imaging shows no distant disease. Sentinel lymph node biopsy (SLNB), undertaken at the same time as surgical excision of the primary tumor, is negative.
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