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Updated: Jun 20, 2026

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Merkel Cell Carcinoma With True Direct Parotid Gland Invasion.

In Ho Jung1, Soon Auck Hong2, Eunsu Yoo3

  • 1Department of Plastic and Reconstructive Surgery, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea.

The Journal of Craniofacial Surgery
|June 18, 2026
PubMed
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This case report details a rare instance of Merkel cell carcinoma (MCC) directly invading the parotid gland. Aggressive surgical resection and reconstruction with an anterolateral thigh flap were successful in managing this advanced skin cancer.

Area of Science:

  • Oncology
  • Dermatology
  • Surgical Oncology

Background:

  • Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine skin cancer.
  • Direct parotid parenchymal invasion by MCC is exceptionally uncommon, often confused with intraparotid nodal metastasis.
  • Accurate differentiation of invasion pathways is crucial for precise staging and treatment planning.

Purpose of the Study:

  • To report an exceptional case of Merkel cell carcinoma with direct parotid parenchymal invasion.
  • To highlight the surgical management and reconstruction techniques for advanced craniofacial MCC.
  • To emphasize the importance of distinguishing true parotid invasion from nodal metastasis for staging.

Main Methods:

  • A case report of a 71-year-old female with a large parotid MCC.
Keywords:
Anterolateral thigh free flapMerkel cell carcinomafacial nerveparotid gland

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  • Surgical intervention included wide en bloc excision, superficial parotidectomy, and selective neck dissection.
  • Reconstruction of a significant defect was achieved using an anterolateral thigh (ALT) free flap.

    • Main Results:

    • Pathology confirmed cutaneous MCC with direct parotid invasion, lymphovascular/perineural invasion, and nodal metastasis (Stage IIIB).
    • The facial nerve trunk was preserved during resection.
    • The ALT free flap remained viable postoperatively, with successful functional preservation of facial nerve function.

    Conclusions:

    • Aggressive surgical resection and reconstruction are feasible and effective for advanced craniofacial MCC with direct parotid invasion.
    • Distinguishing direct parotid invasion from intraparotid nodal metastasis is critical for accurate staging and management.
    • This case underscores successful outcomes with multidisciplinary treatment including adjuvant therapy for high-risk MCC.