{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T22:29:38Z","timestamp":1759530578245,"version":"3.44.0"},"reference-count":15,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,2,6]]},"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:p>The authors present the case of a woman in the seventh decade of life with medical history of: left nephrectomy for renal tuberculosis and non-Hodgkin\u2019s lymphoma treated with chemotherapy (QT) and radiotherapy. She presented with a 2-month history of non-tender, left inguinal lymph node enlargement. Positron Emission Tomography (PET)<jats:underline>\u2014<\/jats:underline>CT \u2014scanshowed hypermetabolic inguinal and retroperitoneal lymphadenopathies, no primary tumour. On the second dermatological examination a pink, 2 cm plaque on the anterior left knee was noted. The histopathological analysis revealed Merkel cell carcinoma. The patient underwent two lines of systemic QT, with life-threatening toxicities limiting treatment. Followed overwhelming disease progression with lymphoedema and numerous skin metastases in the left lower limb. The patient received palliative care until death. The rare incidence of such neoplasia and its uncommon clinical presentation justifies reporting this case and highlights the importance of multidisciplinary teams in the management of cancer patients.<\/jats:p>","DOI":"10.1136\/bcr-2018-224834","type":"journal-article","created":{"date-parts":[[2019,2,22]],"date-time":"2019-02-22T05:37:04Z","timestamp":1550813824000},"page":"e224834","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Unknown primary Merkel cell carcinoma with cutaneous spread"],"prefix":"10.1136","volume":"12","author":[{"given":"Jo\u00e3o Vasco","family":"Barreira","sequence":"first","affiliation":[{"name":"Medical Oncology, Hospital de Santo Antonio dos Capuchos, Lisboa, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7917-1133","authenticated-orcid":false,"given":"Margarida Moura","family":"Valejo Coelho","sequence":"additional","affiliation":[{"name":"Dermatology and Venereology, Centro Hospitalar de Lisboa Central, Lisboa, Lisboa, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catarina","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"Universidade de Coimbra Faculdade de Medicina, Coimbra, Coimbra, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M\u00f3nica","family":"Semedo","sequence":"additional","affiliation":[{"name":"Medical Oncology, Hospital Distrital De Santarem Epe, Santarem, Santar\u00e9m, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,2,21]]},"reference":[{"key":"2025082712461364000_12.2.e224834.1","doi-asserted-by":"crossref","first-page":"doi: bcr2013201675","DOI":"10.1136\/bcr-2013-201675","article-title":"Shared decision-making in treatment of Merkel cell carcinoma","volume":"2014","author":"Muus Steffensen","year":"2014","journal-title":"BMJ Case Rep"},{"key":"2025082712461364000_12.2.e224834.2","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/j.jaad.2012.07.035","article-title":"Unknown primary Merkel cell carcinoma: 23 new cases and a review","volume":"68","author":"Tarantola","year":"2013","journal-title":"J Am Acad Dermatol"},{"key":"2025082712461364000_12.2.e224834.3","unstructured":"NCCN Guidelines: Merkel Cell Carcinoma. 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Nivolumab as neoadjuvant therapy in patients with resectable Merkel cell carcinoma in CheckMate 358. ASCO Annual Meeting 2018. Abstract 9505.","DOI":"10.1200\/JCO.2018.36.15_suppl.9505"},{"key":"2025082712461364000_12.2.e224834.10","doi-asserted-by":"crossref","unstructured":"Nghiem P , Bhatia S , Brohl AS , et al . Two-year efficacy and safety update from JAVELIN Merkel 200 part A: A registrational study of avelumab in metastatic Merkel cell carcinoma progressed on chemotherapy. ASCO Annual Meeting 2018. Abstract 9507.","DOI":"10.1200\/JCO.2018.36.15_suppl.9507"},{"key":"2025082712461364000_12.2.e224834.11","doi-asserted-by":"crossref","unstructured":"Nghiem P , Bhatia S , Lipson EJ , et al . Durable tumor regression and overall survival in patients with advanced merkel cell carcinoma receiving pembrolizumab as first-line therapy. J Clin Oncol 2019:JCO.18.01896. 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