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June 1987

Superior Vena Cava Obstruction From Merkel Cell Carcinoma

Author Affiliations

Department of Radiotherapy; Department of Pathology University of Mississippi Medical Center 2500 N State St Jackson, MS 39216-4505

Arch Dermatol. 1987;123(6):714-716. doi:10.1001/archderm.1987.01660300030008

To the Editor.—  We report a case of Merkel cell carcinoma with superior vena cava obstruction. This tumor was first described in 1875 by Merkel as being an uncommon cell type found in the basal layer of the epidermis, frequently associated with hair follicles and sometimes found in the dermis.

Report of a Case.—  The patient is a 60-year-old man who presented in January 1985 with a cough and a skin lesion on the left side of the face (Fig 1), from which a sample was taken for biopsy. Histologie examination revealed Merkel cell carcinoma (Figs 2 and 3). Chest roentgenogram revealed a right upper lobe mass and right mediastinal lymphadenopathy. Mediastinal node biopsy revealed Merkel cell tumor metastatic from the skin. The patient was treated by intra-arterial infusion of methotrexate on two occasions with regression of the tumor masses. He presented to the radiotherapy department in May 1985 for emergency irradiation for superior vena cava obstruction. The cheek lesion was irradiated, as well as the ipsilateral neck nodes and the pulmonary and mediastinal areas, with excellent response. In August 1985 there were additional metastatic areas and chemotherapy was started. In October the disease progressed with obvious pleural effusion and brain metastasis, and the patient died on Oct 12,1985. Autopsy revealed metastasis to almost every organ in the body.

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