Catastrophic Merkel Cell Carcinoma in a Liver Transplant Recipient

Merkel cell carcinoma (MCC) is a rare skin cancer, is difficult to diagnose, and carries a high mortality rate. Solid organ transplant recipients (SOTR) are at a disproportionately increased risk of MCC and other malignancies due to chronic immunosuppression. We discuss the case of a 47-year-old woman with a remote history of liver transplant on chronic immunosuppression with tacrolimus for over a decade who presented for a third recurrence of MCC on her left forearm. This case report underscores the importance of a risk-stratified approach to regular dermatologic care and skin cancer screening in this vulnerable population.