title: Merkel cell carcinoma: A case of palliative upper limb amputation in a patient with refractory in-transit metastases.
abstract: We report an unusual case of Merkel cell carcinoma in a 70-year-old woman with the rapid development of left upper limb in-transit and hepatic metastases. The patient had a preceding history of left-sided breast cancer. Palliative chemotherapy with carboplatin and etoposide produced a minimal response. The in-transit metastases rapidly progressed and were refractory to chemotherapy and a single fraction of palliative radiotherapy, leading to a marked impact on her quality of life, secondary to sepsis and bleeding. After lengthy discussion, she consented to an above-elbow amputation resulting in a marked improvement in her well-being. In this case, we believe that palliative amputation of the involved arm was justified and beneficial to the patient.
authors.affiliation: Department of Surgery, Crown Princess Mary Cancer Care Centre, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Dakshika A
authors.initials: DA
authors.lastname: Gunaratne
authors.affiliation: Department of Surgical Oncology, Crown Princess Mary Cancer Care Centre, Westmead Hospital, Sydney, New South Wales, Australia.|University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Julie R
authors.initials: JR
authors.lastname: Howle
authors.affiliation: Department of Radiation Oncology and Crown Princess Mary Cancer Care Centre, Westmead Hospital, Sydney, New South Wales, Australia.|University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Veness
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D001132:Arm / Q000601:surgery; D015266:Carcinoma, Merkel Cell / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D005260:Female; D006225:Hand / Q000473:pathology; D006801:Humans; D010166:Palliative Care; D011788:Quality of Life; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery*
keywords: Merkel cell carcinoma; amputation; lymphatic metastasis; palliative care