INTRODUCTION- 
Merkel cell carcinoma is a rare Neuroendocrine malignancy 
arising in the skin. majority of tumor present on face, head 
extremities and trunk and  secondary  sites are skin lymph 
nodes, liver, lung and brain. It appears as esh colored bluish 
red  nodule .sun exposure and having weak immune system 
effect the risk of merkel cel carcinoma. human polyoma virus 
is thought to be etiologic agent in signicant proportion.  Most 
often develops in older people

CASE-
71Yr old male patient presented with swelling over scalp 
region and with itching, crust formation. MRI Brain reveals 
moderately large diffusely inltrating soft tissue lesion 
involving the scalp on right side extending from the level of 
coronal suture  anteriorly for approx. 5.0 cm.

No evidence of calvarial erosion seen.

Patient underwent wide excision scalp and split thickness skin 
skin graft.

HPE was suggestive of merkel cell tumor of scalp skin. Patient 
had not taken any further treatment and again after 6month 
similar lesion developed over the adjoining margins with 
swelling over the bilateral neck region . his CT brain and neck 
revealed recurrent mitotic nmodules involving left para 
median  scalp associated with metastatic lympha den op athy 
in the tyrunk patient again underwent wide excision with RND 
with left SOND  with right parotid lobectomy. HPE reveals 
recurrence of scalp skin. IHC-cytokeratin CK-20 synapt op 
hysin  chromogranin A (focal) c-kit.

Patient received IMRT to neck 2Gy of 30 fraction and mould 
brachytherapy to scalp  34Gy in 10 fraction. patient is on 
follow up without any signs and symptom.

DISCUSSION-
Merkel cell are derived from neural creast and function as 
slowly adapting type 1 mechanoreceptors. Its  a rare 
neuroendocrine tumor it presents as painless skin nodule  
with defuse margin with intact epidermis . regional lymph 
node are seen ij approx. 30% of patients.DD includes 
leukemia amelanotic melanoma metastatic carcinoma 
pyogenic granulomas BCC.

CONCLUSSION -
Merkel cell carcinoma is exceedingly rare but possible tumor 
and can be successfully managed with excision and 
radiotherapy.

REFERENCES
1. https://europepmc.org/article/med/29072302
2. https://cancerres.aacrjournals.org/content/77/13_Supplement/3532
3. h t tps : / / jamane twork .com/ journa ls / jamadermato logy /ar t i c le -

abstract/1881921
4. https://www.sciencedirect.com/science/article/pii/S0959804916325266

A RARE CASE PRESENTATION :MERKEL CELL CARCINOMA OF SCALP 
WITH SECONDARY  NECK.

Original Research Paper

Dr Ramesh Arya 
HOD Radiation Oncology and Superintendent Government Cancer 
Hospital and MGM Medical College Indore 

  X 7GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS

ONCOLOGY

KEYWORDS : Merkel Cell, Polyoma Virus, Imrt, Brachytherapy

VOLUME-9, ISSUE-2, FEBRUARY-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra

Dr. Vipin Kumar 
Dubey*

PG Resident Government Cancer Hospital and MGM Medical College 
Indore *Corresponding Author