Merkel Cell Carcinoma With Lymph Node Metastasis: A Case Emphasizing Early Diagnosis and Multidisciplinary Management

Merkel cell carcinoma (MCC) is a rare but exceptionally aggressive neuroendocrine skin cancer, characterized by low global incidence yet significant clinical impact due to its propensity for early metastasis. Regional lymph node metastases occur frequently, while distant metastases are present in a substantial proportion of patients. The rising incidence over recent decades is largely attributed to the aging global population, associated immunosenescence, and increased cumulative ultraviolet (UV) radiation exposure, particularly UVB radiation. MCC's medical significance lies in its rapid progression, high metastatic potential, and poor prognosis, with survival rates decreasing markedly from localized disease to cases with regional lymph node involvement. This underscores the need for prompt recognition and management to optimize patient outcomes. Key risk factors include advanced age, with an exponential increase in incidence after retirement age, immunosuppression, and chronic sun/UV exposure. Merkel cell polyomavirus has been identified as an important etiologic factor in the majority of cases. This case report describes an elderly female patient who presented with a rapidly growing, ulcerated cervical lesion that had progressed substantially over several months. The lesion was initially misdiagnosed and inadequately treated with minor excision without histopathological analysis. Subsequent rapid local recurrence, extensive regional lymph node involvement, and definitive diagnosis, confirmed by characteristic immunohistochemical staining patterns, highlight the critical need for high clinical suspicion and meticulous histopathological evaluation. Palliative radiotherapy provided measurable clinical benefit, including significant pain relief and notable tumor size reduction. This case exemplifies how deficiencies in initial management can dramatically alter disease trajectory in aggressive malignancies, transforming potentially curable early-stage disease into advanced locoregional involvement requiring palliative treatment with markedly reduced survival expectations.