To the Editor: Merkel cell carcinoma (MCC) is an aggressive neuroendocrine cancer of the skin with a poor prognosis. 1 Dañino-García M. Domínguez-Cruz J. Pérez-Ruiz C. Conejo-Mir J. Pereyra-Rodríguez J. Clinical and epidemiological characteristics of Merkel cell carcinoma in a series of 38 patients. Actas Dermosifiliogr. 2019; 110: 360-365 Crossref PubMed Scopus (6) Google Scholar As with other skin cancers, the anatomic site of presentation may impact prognosis. Several studies have identified primary MCC tumors of the upper extremities as having a better prognosis and head/neck tumors as having a worse prognosis. 1 Dañino-García M. Domínguez-Cruz J. Pérez-Ruiz C. Conejo-Mir J. Pereyra-Rodríguez J. Clinical and epidemiological characteristics of Merkel cell carcinoma in a series of 38 patients. Actas Dermosifiliogr. 2019; 110: 360-365 Crossref PubMed Scopus (6) Google Scholar , 2 Kirchberger M.C. Heppt M.V. Schuler G. Berking C. Heinzerling L. Merkel cell carcinoma of the head and neck compared to other anatomical sites in a real-world setting: importance of surgical therapy for facial tumors. Facial Plas Surg. 2019; 36: 249-254 PubMed Google Scholar , 3 Morand G.B. Madana J. Da Silva S.D. Hier M.P. Mlynarek A.M. Black M.J. Merkel cell carcinoma of the head and neck: poorer prognosis than non-head and neck sites. J Laryngol Otol. 2016; 130: 393-397 Crossref PubMed Scopus (19) Google Scholar , 4 Albores-Saavedra J. Batich K. Chable-Montero F. Sagy N. Schwartz A.M. Henson D.E. Merkel cell carcinoma demographics, morphology, and survival based on 3870 cases: a population based study. J Cutan Pathol. 2010; 37: 20-27 Crossref PubMed Scopus (354) Google Scholar , 5 Agelli M. Clegg L.X. Epidemiology of primary Merkel cell carcinoma in the United States. J Am Acad Dermatol. 2003; 49: 832-841 Abstract Full Text Full Text PDF PubMed Scopus (429) Google Scholar However, many of the studies were small retrospective case series with <75 patients. 1 Dañino-García M. Domínguez-Cruz J. Pérez-Ruiz C. Conejo-Mir J. Pereyra-Rodríguez J. Clinical and epidemiological characteristics of Merkel cell carcinoma in a series of 38 patients. Actas Dermosifiliogr. 2019; 110: 360-365 Crossref PubMed Scopus (6) Google Scholar , 2 Kirchberger M.C. Heppt M.V. Schuler G. Berking C. Heinzerling L. Merkel cell carcinoma of the head and neck compared to other anatomical sites in a real-world setting: importance of surgical therapy for facial tumors. Facial Plas Surg. 2019; 36: 249-254 PubMed Google Scholar , 3 Morand G.B. Madana J. Da Silva S.D. Hier M.P. Mlynarek A.M. Black M.J. Merkel cell carcinoma of the head and neck: poorer prognosis than non-head and neck sites. J Laryngol Otol. 2016; 130: 393-397 Crossref PubMed Scopus (19) Google Scholar Other studies have used Surveillance, Epidemiology, and End Results Program data, but this only captures 34.6% of the American population (sample sizes of 1034-3870 patients). 4 Albores-Saavedra J. Batich K. Chable-Montero F. Sagy N. Schwartz A.M. Henson D.E. Merkel cell carcinoma demographics, morphology, and survival based on 3870 cases: a population based study. J Cutan Pathol. 2010; 37: 20-27 Crossref PubMed Scopus (354) Google Scholar ,5 Agelli M. Clegg L.X. Epidemiology of primary Merkel cell carcinoma in the United States. J Am Acad Dermatol. 2003; 49: 832-841 Abstract Full Text Full Text PDF PubMed Scopus (429) Google Scholar As such, a larger and more nationally representative data set may reach different conclusions.