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April 2013

Merkel Cell Carcinoma: Complete Clinical Remission Associated With Disease Progression

Author Affiliations

Author Affiliations: Service de Dermatologie, Hôpital Saint André, Bordeaux, France (Drs Bertolotti, Conte, François, Dutriaux, Ezzedine, Taieb, and Jouary); Service d’Anatomopathologie, Hôpital Haut Lévêque, Pessac, France (Drs Menard and Vergier).

JAMA Dermatol. 2013;149(4):501-502. doi:10.1001/jamadermatol.2013.2596

Clinical regression is well known in Merkel cell carcinoma (MCC). We report herein a particular case of clinical regression of a primary MCC associated with regional disease progression.

An 80-year-old man presented with 3.5 × 2.0-cm tumor on the tip of the nose that had been present for 3 months without cervical node involvement (Figure 1A). Three biopsy specimens were taken, and MCC was confirmed. On immunochemical analysis, the tumor tested weakly positive for cytokeratin 20 and chromogranin and negative for cytokeratin 7 and thyroid transcription factor 1 (TTF-1). A moderate lymphocytic infiltrate was observed on the biopsy specimens, with CD4+ lymphocytes arranged mainly around the tumor and fewer CD8+ lymphocytes located mainly within the tumor (Figure 2). One month later, the patient presented with both a complete regression of the tumor on the nose and enlargement of cervical bilateral lymph nodes (Figure 1B). The patient reported that the tumor had spontaneously regressed within the week following the biopsies. Hypermetabolic uptake was observed on multiple right and left cervical enlarged nodes, but the nose area was found to be normal (Figure 1C and D) on positron-emission tomography.

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