Ann Dermatol.  2012 Feb;24(1):77-80. 10.5021/ad.2012.24.1.77.

Merkel Cell Carcinoma Concurrent with Bowen's Disease

• Park HC
• Kang HS
• Park KT
• Oh YH
• Yu HJ
• Kim JS

• KMID: 2156861
• DOI: http://doi.org/10.5021/ad.2012.24.1.77

Abstract

Merkel cell carcinoma (MCC) is a rare, aggressive cutaneous malignancy of the elderly and immunocompromised patients. It is occasionally found coexisting with other diseases, such as squamous cell carcinoma, basal cell carcinoma, actinic keratosis, miscellaneous adnexal tumors, and rarely Bowen disease. A 75-year-old woman presented with a 6-month history of an irregularly shaped erythematous patch on the left mandibular angle. Three months later, a 1.5x1.0 cm sized painless and rapidly growing erythematous nodule developed on the patch. Microscopically, the patch lesion was consistent with that of Bowen disease. The nodular lesion showed a number of small uniform hyperchromatic cells with scanty cytoplasm. It showed dense small-cell like nodular infiltration in the dermis. Immunohistochemical staining for cytokeratin 20 showed a positive result with a dot-like perinuclear pattern. Additionally, the result for thyroid transcription factor-1 was negative, which is positive in small cell neuroendocrine carcinoma. From these findings, we diagnosed this lesion as MCC concurrent with Bowen disease.

Keyword

Bowen disease; Merkel cell carcinoma

MeSH Terms

Aged
Bowen's Disease
Carcinoma, Basal Cell
Carcinoma, Merkel Cell
Carcinoma, Neuroendocrine
Carcinoma, Squamous Cell
Cytoplasm
Dermis
Female
Humans
Immunocompromised Host
Keratin-20
Keratosis, Actinic
Thyroid Gland
Keratin-20

Figure

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  Fig. 1 The erythematous nodule based on an irregular shaped erythematous patch is seen on the left mandibular angle.

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  Fig. 2 (a) "Windblown appearance" of the epidermis on the patch lesion (H&E, ×200). (b) Numerous small uniform tumor cells with round hyperchromatic nuclei and scanty cytoplasm are arranged nodular infiltration in the dermis on the nodular lesion (H&E, ×100). (c) Cytokeratin 20 was stained positive in a dot-like perinuclear pattern (×200). (d) Immunohistochemical staining of tumor cells showing negativity for thyroid transcription factor 1 (×200).

Reference

1. Nghiem P, Jaimes N. Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, editors. Merkel cell carcinoma. Dermatology in general medicine. 2008. 7th ed. New York: McGraw-Hill;1087–1094.

2. Sirikanjanapong S, Melamed J, Patel RR. Intraepidermal and dermal Merkel cell carcinoma with squamous cell carcinoma in situ: a case report with review of literature. J Cutan Pathol. 2010. 37:881–885.

3. Toker C. Trabecular carcinoma of the skin. Arch Dermatol. 1972. 105:107–110.

4. Tang CK, Toker C. Trabecular carcinoma of the skin: an ultrastructural study. Cancer. 1978. 42:2311–2321.

5. Schenk P, Konrad K. Merkel cell carcinoma of the head and neck associated with Bowen's disease. Eur Arch Otorhinolaryngol. 1991. 248:436–441.

6. Okamoto O, Yoshiyama M, Takayasu S, Yokoyama S. Merkel cell carcinoma: report of three cases. J Dermatol. 1998. 25:45–50.

7. Tsuruta D, Hamada T, Mochida K, Nakagawa K, Kobayashi H, Ishii M. Merkel cell carcinoma, Bowen's disease and chronic occupational arsenic poisoning. Br J Dermatol. 1998. 139:291–294.

8. Moon YJ, Yi JH, Choi HS, Yun SK, Kim HU, Ihm CW. A case of merkel cell carcinoma in association with bowens disease. Korean J Dermatol. 2004. 42:309–312.

9. Sarma DP, Wang B, Shehan J, Linder-Stephenson L. Concurrent Merkel cell carcinoma and Bowen's disease of the thigh. Int J Dermatol. 2007. 5.

10. Smith KJ, Skelton HG 3rd, Holland TT, Morgan AM, Lupton GP. Neuroendocrine (Merkel cell) carcinoma with an intraepidermal component. Am J Dermatopathol. 1993. 15:528–533.

11. Gomez LG, DiMaio S, Silva EG, Mackay B. Association between neuroendocrine (Merkel cell) carcinoma and squamous carcinoma of the skin. Am J Surg Pathol. 1983. 7:171–177.

12. Lien HC, Tsai TF, Lee YY, Hsiao CH. Merkel cell carcinoma and chronic arsenicism. J Am Acad Dermatol. 1999. 41:641–643.