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Merkel Cell Carcinoma in a Patient With CLL/Atypical AML

A 77-year-old man with chronic lymphocytic leukemia (CLL)/ atypical acute myeloid leukemia (AML) presented with an asymptomatic firm, mobile, violaceous subcutaneous nodule on his back for 10 months (A). Histopathology showed a monomorphic small cell infiltrate (B) with immunoreactivity for neuron specific enolase, synaptophysin, and cytokeratin 20, consistent with the diagnosis of Merkel cell carcinoma (MCC). The patient underwent wide local excision and sentinel lymph node biopsy. The lymph nodes were positive for both CLL and MCC, and he is being treated with the immune checkpoint inhibitor pembrolizumab. MCC is an aggressive tumor, whereby timely diagnosis and treatment are essential for improved prognosis.