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January 1988

Superior Vena Cava Obstruction From Merkel Cell Carcinoma

Author Affiliations

Institute of Pathology Royal Victoria Hospital Belfast BT12 6BA, Northern Ireland

Arch Dermatol. 1988;124(1):21. doi:10.1001/archderm.1988.01670010011004

To the Editor.—  In the June 1987 issue of the Archives, Routh et al1 presented a case report of a 60-year-old man who presented initially with a skin lesion on his face, and with a cough. A mass was noted in the right upper lobe of the lung by chest roentgenogram. A biopsy specimen of both the skin nodule and the mediastinal lymph nodes revealed a similar histologic appearance of neuroendocrine tumor cells. The authors diagnosed this lesion as a primary Merkel cell tumor of the skin with secondary spread to the lung and the mediastinal lymph nodes. They state that "Merkel cell carcinoma should be differentiated from metastatic carcinoma," and yet no attempt has been made to do so in this case presentation. An alternative diagnosis would surely be a primary oat cell carcinoma of the lung, with spread to mediastinal lymph nodes, and with a secondary deposit