An unusual presentation of merkel cell carcinoma of the eyelid

Merkel cell carcinoma is a rare primary neuroendocrine tumor occurring on any part of the body. It usually presents as a firm, nontender, violaceous, or purple nodule located on areas of the body that have been exposed to sunlight. A 68-year-old female presented with a rapidly growing lesion on the left lower eyelid from 6 weeks. Examination showed a 4 cm diameter, exophytic, ovoid skin lesion of the left lower lid. Wide local excision of this lesion was followed by adjuvant chemotherapy. Histological examination of therapeutic frozen section of the lesion and the presence of neuroendocrine marker and cytokeratin markers established the diagnosis of Merkel Cell carcinoma. The follow-up at 8 months was uneventful. Merkel cell carcinoma can have an unusual presentation of a large, exophytic, oval lesion resembling a basal cell carcinoma. Merkel cell carcinoma has predilection for rapid spread; hence, in a case of lid lesions, a suspicion for this diagnosis should be kept in mind.