Clinical-pathological correlation and outcomes of eyelid Merkel cell carcinoma: A series of four cases

Merkel cell carcinoma (MCC) of the eyelid is an uncommon but highly aggressive neuroendocrine malignancy characterised by rapid growth, early locoregional and distant spread, and a high rate of recurrence. We present a series of four cases of palpebral MCC to highlight clinical presentation, histopathological features, treatment approaches, and clinical outcomes. Patients exhibited rapidly progressive eyelid tumours with variable degrees of local invasion. Histopathological analysis confirmed neuroendocrine carcinoma with an immunohistochemical profile characteristic of MCC, including CK20 positivity in a perinuclear dot-like pattern and expression of neuroendocrine markers. Management included surgical excision with reconstructive procedures and, in selected cases, adjuvant radiotherapy. Clinical evolution varied, reflecting the heterogeneous behaviour of this tumour. This case series emphasises the importance of early recognition, accurate histopathological diagnosis, and a multidisciplinary approach for optimal management of eyelid MCC.