A 72-year-old woman presented to our clinic with a rapidly growing erythematous nodular skin lesion on her scalp with a 5-month history of progressive loss of potency topical corticoids that did not improve.
Biopsy of the lesion revealed Merkel's tumor.
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No cervical lymphadenopathies were detected.
Preoperative analysis, including tumor markers, normal except blood glucose value 177.
Cervical CT showed no findings of cervical lymph node involvement, and there was only a lesion in the right malar region that coincided with the external location of the lesion.
No bone involvement was observed.
Abdominal CT scan revealed no signs suggestive of systemic invasion.
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Under general anesthesia, the lesion was excised with oncological margins and reconstructed with a cutaneous cervicofacial rotation-discharge flap.
Subsequently, external radiotherapy was administered with a total cumulative dose of 60 Gy.
12 months after the surgical intervention, the patient presented in a scheduled review a submandibular tumor whose FNAB was reported as a neck metastasis of cutaneous melanoma of Merkel cells.
Radical cervical dissection was performed, which resulted in two lymph nodes, none of them presenting extracutaneous involvement.
