Multilamellar Reconstruction Using Tarsal Graft and Tripier Flap in Upper Eyelid Merkel Cell Carcinoma: A Case Report

Background: Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine tumor of the skin, typically affecting elderly or immunosuppressed patients. Eyelid involvement represents 5–10% of cases and usually requires both oncologic and reconstructive considerations due to the anatomical complexity of the periocular region. We report a 73-year-old male with a painless violaceous swelling of the right upper eyelid of three months’ duration. Incisional biopsy confirmed MCC positive for synaptophysin, chromogranin, and cytokeratin 20, with a Ki-67 index of 70%. The patient underwent wide local excision with 7-mm margins, sentinel lymph node biopsy, and complex multilamellar reconstruction using a free tarsal graft, advancement of the residual superior tarsus, and a Tripier flap. Histopathology confirmed MCC with vascular invasion and tumor-free margins (closest margin 0.4 mm). Sentinel nodes showed mixed hyperplasia without metastasis. Postoperatively, the patient had good functional and aesthetic outcomes. This case highlights the importance of early diagnosis, appropriate oncologic management, and tailored multilamellar reconstruction to achieve optimal results in upper eyelid MCC. Keywords: Merkel cell carcinoma, upper eyelid reconstruction, tarsal graft, Tripier flap, sentinel lymph node biopsy.