Merkel-Cell Carcinoma ( 2 фото )

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A 72-year-old woman presented to the dermatology clinic with a 3.5-month history of an enlarging, painless lump on her left cheek. Physical examination showed a dome-shaped, reddish nodule surrounded by erythema on the left cheek (Panel A). The nodule had a shiny surface and central hemorrhagic crust. A punch biopsy of the lesion revealed dermal infiltration by small, round, blue cells arranged in nests, as well as scant cytoplasm and hyperchromatic nuclei; mitoses were frequently observed (Panel B, hematoxylin and eosin stain). Immunohistochemical testing was positive for perinuclear CK20 and synaptophysin. A diagnosis of Merkel-cell carcinoma — a rare, aggressive cutaneous neuroendocrine carcinoma — was made. Merkel-cell carcinoma typically manifests as a rapidly enlarging, nontender, shiny nodule on sun-exposed skin in an older person. Risk factors include ultraviolet radiation, immunosuppression, and infection with Merkel-cell polyomavirus (testing for which was not available in this patient). Immunotherapy may be used in widespread disease, but no metastases were seen on staging imaging in this patient. Wide local excision of the lesion was performed, and sentinel lymph-node biopsy of the neck was negative. Adjuvant radiotherapy was administered to enhance local disease control. At 6 months of follow-up, no recurrence was noted.
Zunaid Ahmed, M.B., Ch.B. , and Willem Visser, M.B., Ch.B.
Published December 17, 2025
N Engl J Med 2025;393:2459
DOI: 10.1056/NEJMicm2513302
VOL. 393 NO. 24


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