Unusual presentation of a Merkel cell carcinoma

Merkel cell carcinoma (MCC) is an uncommon, potentially lethal, cutaneous t umor that mainly occurs in sun-exposed skin of the head and neck area of th e elderly. We report a case of MCC presenting as a 2-mm crusted erosion on the nose of an elderly patient, the smallest MCC reported thus far in the l iterature. The optimal management of MCC has not been clearly established. In view of its high local recurrence rate, predilection to metastasis, and significant mortality, aggressive treatment has been advocated. Identificat ion of this tumor at such a small size posed a management dilemma because o f lack of prospective treatment data involving biologic markers of prognost ic significance for MCC.