Atypical presentation of Merkel cell carcinoma with pulmonary embolism

Merkel cell carcinoma (MCC) is a rare aggressive neuroendocrine malignancy that typically presents in the skin and rapidly progresses to other body parts. MCC is typically found in sun-exposed areas, mainly the head and neck region as well as the upper limbs and shoulders. It typically affects fair-skinned elderly males. In this report, we present an unusual MCC case of a 48-year-old Caucasian male with an initial presentation of a massive pulmonary embolism. Further work-up of our patient indicated no typical MCC skin presentation, but rather metastases of the disease. The goal of this report is to highlight the importance of considering MCC as a differential even when patients do not present with common MCC risk factors or skin presentations.