title: A case report of Merkel cell carcinoma on chronic lymphocytic leukemia: differential diagnosis of coexisting lymphadenopathy and indications for early aggressive treatment.
abstract: BACKGROUND
  Chronic lymphocytic leukemia (CLL) is a monoclonal disorder, characterized by a progressive proliferation of functionally incompetent B lymphocytes. There is increased evidence of association between CLL and skin cancers, including the uncommon Merkel cell carcinoma (MCC).
  
  
  METHODS
  A case report of an 84-year old male, who presented with an aggressively recurrent form of MCC on the lower lip, on the background of an 8-year history of untreated CLL. During the recurrences of MCC, coexisting regional lymphadenopathy, posed a problem in the differential diagnosis and treatment of lymph node involvement. Histopathology and immunoistochemistry showed that submandibular lymphadenopathy coexisting with the second recurrence of MCC, was due to B-cell small lymphocytic lymphoma. The subsequent and more aggressive recurrence of the skin tumor had involved the superficial and deep cervical lymph nodes. Surgical excision followed by involved field radiation therapy has been proven effective for both malignancies.
  
  
  CONCLUSIONS
  MCC has a high incidence of regional lymphadenopathy at presentation (12-45%) and even when it arises on the background of chronic leukemia, lymphadenopathy at presentation should be managed agressively with elective lymph node dissection. We overview the postulated correlation between Merkel tumor and CCL, the differential diagnosis of regional lymphadenopathy during the recurrences of the skin tumor and the strategies of treatment.
authors.affiliation: St Andrews Center of Burns and Plastic Surgery, Broomfield Hospital, Chelmsford, CM1 7ET, UK. papageorgiouk@doctors.org.uk
authors.forename: K I
authors.initials: KI
authors.lastname: Papageorgiou
authors.forename: M G
authors.initials: MG
authors.lastname: Kaniorou-Larai
mesh_terms: D000369:Aged, 80 and over; D015266:Carcinoma, Merkel Cell / Q000150:complications / Q000175:diagnosis*; D003937:Diagnosis, Differential; D006801:Humans; D007150:Immunohistochemistry; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications / Q000175:diagnosis*; D008048:Lip Neoplasms / Q000378:metabolism / Q000473:pathology; D008206:Lymphatic Diseases / Q000150:complications / Q000175:diagnosis*; D008207:Lymphatic Metastasis; D008297:Male; D009362:Neoplasm Metastasis; D012008:Recurrence; D012878:Skin Neoplasms / Q000150:complications / Q000175:diagnosis