Metastatic Merkel cell carcinoma of the spine

Abstract

Merkel cell carcinoma is a rare neuroendocrine malignancy, primarily affecting sun-exposed skin. The mean age at presentation is 75 years. To our knowledge there have been only four patients with spinal metastasis reported previously, with one patient alone having a marked neurological deficit requiring surgical decompression. We report a 73-year-old male who presented with rapidly progressive paraplegia 6 months following excision of a primary cutaneous Merkel cell lesion. He had a metastatic deposit at T6 comprising a canal filling epidural component with local aggressive bone destruction. He required emergent surgical decompression and unilateral pedicle screw stabilization. Unfortunately, this patient died 1 month postoperatively, succumbing to overwhelming metastatic disease. This report highlights the locally aggressive nature of metastatic Merkel cell tumor and the very poor prognosis in those patients who develop spinal column metastases.