Merkel cell carcinoma arising from the subcutaneous fat of the arm with intact skin.
BACKGROUND
Merkel cell carcinoma is a rare malignant neuroendocrine neoplasm characteristically arising from the dermis of sunlight-exposed skin. It rarely arises outside the skin.


OBJECTIVE
We present a patient with primary Merkel cell carcinoma arising from subcutaneous fat, with no involvement of the overlying skin. We describe the clinical manifestations and magnetic resonance imaging (MRI) findings.


METHODS
We report a 63-year-old woman with a primary lesion of Merkel cell carcinoma that arose from the subcutaneous fat layer of the left arm. The lesion presented as a subcutaneous nodule with intact overlying skin. MRI showed that the nodular lesion was located entirely in the subcutaneous fat layer, with no involvement of the dermis. Peritumoral infiltration around the lesion and enlarged lymph nodes deep to the lesion were noted. The patient received wide excision of the lesion with dissection of the regional lymph nodes and adjuvant radiotherapy and chemotherapy.


RESULTS
Histopathologic examination confirmed the diagnosis of Merkel cell carcinoma with local lymphatic metastasis, and the lesion was completely located in the subcutaneous fat, with no involvement of the dermis. These findings were well correlated with MRI findings.


CONCLUSIONS
Primary Merkel cell carcinoma may arise from the subcutaneous fat and present as an entirely subcutaneous lesion with intact skin. MRI is helpful to evaluate the local extension of the lesion and regional lymphatic metastasis.
Department of Radiology, Tri-Service General Hospital, National Defence Medical Center, Taipei, Taiwan. gsh5@seed.net.tw
Guo-Shu
GS
Huang
Wei-Chou
WC
Chang
Herng-Sheng
HS
Lee
John A M
JA
Taylor
Tiang-Yeu
TY
Cheng
Cheng-Yu
CY
Chen
D001132:Arm; D015266:Carcinoma, Merkel Cell / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D018205:Neoplasms, Adipose Tissue / Q000601:surgery*; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology