title: An unusual presentation of periocular Merkel cell carcinoma.
abstract: OBJECTIVE
  Merkel cell carcinoma (MCC) is an uncommon but potentially aggressive tumor. We describe a rare presentation of MMC of the upper lid.
  
  
  METHODS
  A 63-year-old male presented with a 3-month history of right upper lid fullness. Examination revealed a large multinodular mass protruding into the conjunctival aspect of the eyelid. An enlarged right submandibular lymph node was also noted.
  
  
  RESULTS
  An incisional biopsy was suggestive of MCC. Staged surgical excision with rapid paraffin sections was performed. The tumor cells were seen invading the tarsal plate and adjacent to the palpebral conjunctiva but not into the epidermis. MCC was confirmed using immunohistochemical stains and neuroendocrine markers (cytokeratins Cam 5.2, AE1/3, CK20, chromogranin, synaptophysin, and Leu 7). The lymph node biopsy was also confirmed as metastatic MCC. The patient was treated with postsurgical chemotherapy and radiotherapy, with no recurrence during a 6 months follow-up period.
  
  
  CONCLUSIONS
  Although uncommon, periocular MCC may present as an atypical conjunctival multinodular mass.
authors.affiliation: Oculoplastic & Orbital Unit, Department of Ophthalmology & Visual Sciences, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia. leiboigaI5@yahoo.com
authors.forename: Igal
authors.initials: I
authors.lastname: Leibovitch
authors.forename: Garry
authors.initials: G
authors.lastname: Davis
authors.forename: Shyamala C
authors.initials: SC
authors.lastname: Huilgol
authors.forename: John
authors.initials: J
authors.lastname: Crompton
authors.forename: Craig L
authors.initials: CL
authors.lastname: James
authors.forename: Dinesh
authors.initials: D
authors.lastname: Selva
mesh_terms: D014408:Biomarkers, Tumor / Q000378:metabolism; D001706:Biopsy; D015266:Carcinoma, Merkel Cell / Q000378:metabolism / Q000473:pathology* / Q000628:therapy; D005142:Eyelid Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000628:therapy; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008198:Lymph Nodes / Q000378:metabolism / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged
chemical_list: D014408:Biomarkers, Tumor