PLASTİK REKONSTRÜKTİF
EDİTÖRE MEKTUP
LETTER TO THE EDITOR
ve ESTETİK CERRAHİ DERGİSİ TÜRKwww.turkplastsurg.org
142Cilt 23 / Sayı 3 2015
Geliş Tarihi : 21.02.2014 Kabul Tarihi : 03.12.2014
*Haydarpasa Numune Training and Research Hospital Plastic and Reconstructive Surgery Clinic, ISTANBUL
**Sinop Atatürk State Hospital, Plastic and Reconstructive Surgery Clinic, SiNoP
***Haydarpaşa Numune Training and Research Hospital Pathology Clinic, ISTANBUL
*N.Sinem Çiloğlu, **Alpay Duran, *Hasan Büyükdoğan, *Erkin Önsal, ***Elif Sayman
MERKEL HüCRELİ KaRSİnOM: PaRMağIn Ray aMPüTaSyOnU MERKEL CELL CaRCInOMa: Ray aMPUTaTIOn Of THE DIgIT
Dear Editor;
Merkel cell carcinoma (MCC) is a rare, aggressive tumor of the skin. It was first described by Toker in 1972 as trabecular carcinoma. It’s derived from Merkel cells which exhibits neuroendocrine features at the dermoe- pidermal junction. Clinically, it’s seen as single, painless, fast-growing, red blue colored ulcerated nodules. The increasing incidence of MCC over the past 15 years in concern with their biologically aggressive nature de- mand prompt diagnosis and treatment of this disease.
A 73-years-old male patient has been referred to our clinic because of a 3x4 cm nodule on the third finger of his right hand. There was no epitrochlear or axillary lymphadenopathy on physical examination and no evidence of distant metastases on metastatic work up. Amputation of the third ray was performed under general anesthesia (Figure 1-2). Immunohistochemical staining revealed that the neoplastic cells expressed cytokeratin 20 (CK20) in a perinuclear dot-like fashion (Figure 3). The patient was referred to oncology clinic postoperatively. He is followed up every 6 months, and is disease free for 4 years.
The highest incidence of MCC is seen in Caucasian men, older than 65 years of age. According to the surve- illance, epidemiology and end results data, only 49% of patients present with localized disease, with 19.3% pre- senting with a primary lesion of the upper limb. only ten well documented cases of MCC on the finger have been reported previously in the literature.1-5 Mikolyzk and Bernard reported two cases of MCC treated with ray amputation and sentinel lymph node sampling with greater than 5 years of follow up.1 Also, they suggested that ray resection of the digit may be curative in the ab- sence of metastatic disease. Similarly, our case has been disease free for more than 4 years. In conclusion, due to the local recurrence, regional and distant metastases
rates are extremely high in MCC, careful peroperative assessment and appropriate treatment according to tu- mor location may be lifesaving.
figure 1. Preoperative view of the mass
figure 2. Immunohistochemical staining with cytokeratin 20
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Turk Plast Surg 2015;23(3)
Dr. N. Sinem ÇİLOğLu
Haydarpaşa Numune Training and Research Hospital, Plastic, Reconstructive and Aesthetic Clinic, ISTANBUL E-mail: eroglusinem@yahoo.com
Merkel cell carcinoma
KaynaKLaR
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of two cases. J Hand Surg Am. 2008;33: 404–6.
Daghistani W, Younan R, Brutus JP. Merkel cell carcinoma 2.
of the hand: case report and literature review. Chir Main.
2010;29(2):128-31.
Spalvieri C, Brunelli F, Bachmeyer CC. Merkel cell tumour of the 3.
finger. Scand J Plast Reconstr Surg Hand Surg. 2007;41(3):149- 51.
Simstein NL, Sduggs NK. Merkel cell tumor: two cases. Int Surg.
4.
1998;83(1):60-2.
Covello R, Licci S, Ferrari A, Morelli L, Catricalà C .Merkel cell car- 5.
cinoma of the thumb with squamous and leiomyosarcomatous differentiation. Eur J Dermatol. 2010;20(4):529-30.
figure 3. Postoperative view of the patient
