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Merkel cell carcinoma with divergent differentiation
K Gaitskell1, S Nassar2, H Ibrahim1,3
1Department of Cellular Pathology, Royal Free Hospital, London, UK.
Clinical and Experimental Dermatology
|October 4, 2019
Summary
Merkel cell carcinoma (MCC), a rare skin cancer, can exhibit divergent differentiation into squamous or adnexal types. Recognizing this is crucial, as recurrences may solely display the Merkel cell component.
Area of Science:
- Dermatology
- Pathology
- Oncology
Background:
- Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine skin cancer primarily affecting elderly individuals on sun-exposed skin.
- While rare, divergent differentiation in MCC has been previously documented in case series.
Observation:
- Two new cases of MCC with divergent differentiation are presented.
- Case 1: A 96-year-old male with a scalp lesion showed MCC with divergent squamous differentiation.
- Case 2: An 87-year-old female with a leg lesion initially diagnosed as squamous cell carcinoma was found to have MCC with divergent differentiation (likely trichilemmal carcinoma); recurrence showed only MCC.
Findings:
- These cases confirm that MCC can differentiate into squamous and adnexal morphologies.
- The divergent differentiation can complicate initial diagnosis, with subsequent recurrences potentially losing the divergent features.
Implications:
- Accurate diagnosis of MCC with divergent differentiation is critical for appropriate patient prognosis and management.
- Delayed or incorrect diagnosis can lead to inadequate treatment, as metastatic or recurrent disease may present solely as MCC.
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