Merkel cell carcinoma: case report and literature review, from a remote region of France.
BACKGROUND
Merkel cell carcinoma (MCC) is a rare and aggressive skin cancer. The first case was described by Toker in 1972 as a trabecular carcinoma of the skin. The most accepted origin of MCC is the Merkel cell (touch receptor). Merkel cell carcinoma occurs mostly in Caucasians aged over 65 years as a dome-shaped purple node on the head, neck or extremities.


METHODS
This report describes a case of MCC of 0.5 cm size, located on the left upper leg. The patient was Caucasian, female and aged 69 years with the specific risk factor of a history of sun exposure on the beach for 50 years. The excision biopsy returned a diagnosis of MCC. The excision of the biopsy scar, with clear margins of 3 cm and to a depth of 3 cm was performed 2 days later and returned a result of no MCC cells present. Biological tests were normal. No lesions were detected on CT scan of thorax and abdomen. No dissemination was detected on PET scan. It was ranked as stage I MCC. National Cancer Institute guidelines (2007) were used for follow up: physical examination every 3 months, PET scan every 6 months for 1 year; after this physical examination every 6 months and PET scan every year for 5 years.


CONCLUSIONS
The role of the primary care physician operating in remote location is crucial for the early detection of skin cancers. Early detection is the only chance for a patient to survive an MCC. Every primary care physician operating in a remote location should master the surgical technique for excision biopsy, the gold standard for diagnosis of skin cancers.
Zucchi
S
S
General Medical Practice, Belmont de la Loire, France.
D000368:Aged; D015266:Carcinoma, Merkel Cell / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D003937:Diagnosis, Differential; D055088:Early Detection of Cancer; D005260:Female; D005602:France; D006801:Humans; D007866:Leg / Q000473:pathology; D008207:Lymphatic Metastasis; D011320:Primary Health Care; D012307:Risk Factors; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery