{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:03:08Z","timestamp":1756339388267,"version":"3.44.0"},"reference-count":17,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,5,30]]},"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:p>Merkel cell carcinoma (MCC) is a rare but highly aggressive cutaneous tumour. Most tumours occur in the head and neck, extremities or torso and 36% of them involve the face. Bone marrow involvement in MCC is rare and to our knowledge only nine cases reported in the English literature. Bone marrow biopsy is not usually performed to stage MCC; thus, the true incidence of bone marrow involvement may be under-reported. The majority of the cases reported in the literature have some form of immunosuppression, which suggests a strong association. We report a case of extensive bone marrow involvement from MCC in an 80-year-old Caucasian woman with a history of rheumatoid arthritis treated with adalimumab, methotrexate and prednisone. It may be prudent to include bone marrow biopsy in the staging of MCC in immune-compromised patients.<\/jats:p>","DOI":"10.1136\/bcr-2019-234234","type":"journal-article","created":{"date-parts":[[2020,6,29]],"date-time":"2020-06-29T02:25:27Z","timestamp":1593397527000},"page":"e234234","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Bone marrow involvement with Merkel cell carcinoma"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7743-7740","authenticated-orcid":false,"given":"Ahmad","family":"Khan","sequence":"first","affiliation":[{"name":"West Virginia University Robert C Byrd Health Sciences Center Charleston Division, Charleston, West Virginia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shahroz","family":"Adil","sequence":"additional","affiliation":[{"name":"Mercy Health Saint Mary's, Grand Rapids, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oscar C","family":"Estalilla","sequence":"additional","affiliation":[{"name":"Charleston Area Medical Center, Charleston, West Virginia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven","family":"Jubelirer","sequence":"additional","affiliation":[{"name":"Charleston Area Medical Center, Charleston, West Virginia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,6,28]]},"reference":[{"key":"2025082701193879000_13.6.e234234.1","doi-asserted-by":"crossref","first-page":"e519","DOI":"10.14694\/EdBook_AM.2015.35.e519","article-title":"Merkel cell carcinoma: emerging biology, current approaches, and future directions","author":"Tothill","year":"2015","journal-title":"Am Soc Clin Oncol Educ Book"},{"key":"2025082701193879000_13.6.e234234.2","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1016\/j.jaad.2017.10.028","article-title":"Merkel cell carcinoma: current US incidence and projected increases based on changing demographics","volume":"78","author":"Paulson","year":"2018","journal-title":"J Am Acad Dermatol"},{"key":"2025082701193879000_13.6.e234234.3","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0560.2009.01370.x"},{"key":"2025082701193879000_13.6.e234234.4","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.1972.01620040075020"},{"key":"2025082701193879000_13.6.e234234.5","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-199912150-00015"},{"key":"2025082701193879000_13.6.e234234.6","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdq308"},{"key":"2025082701193879000_13.6.e234234.7","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djq120"},{"key":"2025082701193879000_13.6.e234234.8","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/dju382"},{"key":"2025082701193879000_13.6.e234234.9","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1007\/s11154-017-9433-0","article-title":"Merkel cell carcinoma: epidemiology, pathogenesis, diagnosis and therapy","volume":"18","author":"Amaral","year":"2017","journal-title":"Rev Endocr Metab Disord"},{"key":"2025082701193879000_13.6.e234234.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2007.11.020"},{"key":"2025082701193879000_13.6.e234234.11","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-016-5266-4"},{"key":"2025082701193879000_13.6.e234234.12","doi-asserted-by":"crossref","first-page":"2360","DOI":"10.1245\/s10434-011-2213-2","article-title":"Merkel cell carcinoma of unknown primary origin","volume":"19","author":"Deneve","year":"2012","journal-title":"Ann Surg Oncol"},{"key":"2025082701193879000_13.6.e234234.13","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.12376"},{"key":"2025082701193879000_13.6.e234234.14","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1159\/000337411","article-title":"Dermoscopy of Merkel cell carcinoma","volume":"224","author":"Dalle","year":"2012","journal-title":"Dermatology"},{"key":"2025082701193879000_13.6.e234234.15","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1097\/SLA.0b013e31822c5fc1","article-title":"Five hundred patients with Merkel cell carcinoma evaluated at a single institution","volume":"254","author":"Fields","year":"2011","journal-title":"Ann Surg"},{"key":"2025082701193879000_13.6.e234234.16","first-page":"1007","article-title":"Metastatic Merkel cell carcinoma in the bone marrow of a patient with plasma cell myeloma and therapy-related myelodysplastic syndrome","volume":"5","author":"Kressin","year":"2012","journal-title":"Int J Clin Exp Pathol"},{"key":"2025082701193879000_13.6.e234234.17","first-page":"1","article-title":"Concurrent hairy cell leukemia and metastatic Merkel cell carcinoma","volume":"2018","author":"Prakash","year":"2018","journal-title":"Case Rep Oncol Med"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2019-234234","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T08:19:48Z","timestamp":1756282788000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2019-234234"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6]]},"references-count":17,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2020,6,28]]},"published-print":{"date-parts":[[2020,6]]}},"alternative-id":["10.1136\/bcr-2019-234234"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2019-234234","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2020,6]]}}}