Epidermotropic Merkel cell carcinoma: A case series with histopathologic examination

D'Agostino, Mark; Cinelli, Christina; Willard, Robert; Hofmann, Jeffrey; Jellinek, Nathaniel; Robinson-Bostom, Leslie

doi:10.1016/j.jaad.2009.06.023

« Previous Next »Journal of the American Academy of Dermatology
Volume 62, Issue 3 , Pages 463-468, March 2010

Epidermotropic Merkel cell carcinoma: A case series with histopathologic examination

Mark D'Agostino, MD, MS, MSc
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
Christina Cinelli, MD
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
Robert Willard, MD
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
Jeffrey Hofmann, MD
- Department of Surgery (Ophthalmology), Warren Alpert Medical School of Brown University, Providence, Rhode Island
Nathaniel Jellinek, MD
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
Leslie Robinson-Bostom, MD
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Correspondence to: Leslie Robinson-Bostom, MD, Department of Dermatology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy St, APC-10, Providence, RI 02903.

Background

Merkel cell carcinoma (MCC), an aggressive malignancy that has been increasing in incidence, rarely presents with an epidermotropic pattern.

Objective

We conducted an immunohistochemical evaluation of 6 previously unpublished cases of epidermotropic MCC, focusing particularly on the staining characteristics of epithelial membrane antigen and cytokeratin-20 in the hope of providing insight into the mechanism of epidermotropism in MCC.

Methods

This study is a retrospective evaluation using light microscopy and immunohistochemistry.

Results

Forty cases of MCC with pathology at Rhode Island Hospital and the Miriam Hospital in Providence, RI, from 1983 through 2009 were reviewed. Following exclusion criteria, 6 patients (5 men, 1 woman) with a mean age of 82.5 years (range, 72-92) demonstrated epidermotropism. Three of 6 patients had MCC of the eyelid. In cases 1, 3, and 6, the perinuclear dot pattern observed with cytokeratin-20 in the epidermotropic MCC cells was less pronounced than the pattern observed in the dermis, and in all 6 of the tumors, the epidermal staining pattern observed with epithelial membrane antigen was not more or less prominent than the staining observed in the dermis.

Limitations

The small total number of cases of epidermotropic MCC is a limitation.

Conclusion

The data presented reinforce the differential diagnosis of tumors with an epidermotropic growth pattern and the importance of immunohistochemical staining in the histologic workup of such tumors: squamous cell carcinoma in situ, melanoma, mycosis fungoides, eccrine porocarcinoma, sebaceous carcinoma of the eyelid, mammary and extramammary Paget disease, MCC, and epidermotropic metastases. It is notable that 3 of 6 identified tumors were located on the eyelid; further study of epidermotropic MCC may shed more light on this finding, either as an unusual coincidence or a finding with unexplained significance.

Key words: eccrine porocarcinoma, epidermotropic metastases, epidermotropism, mammary and extramammary Paget disease, melanoma, Merkel cell carcinoma, mycosis fungoides, sebaceous carcinoma of the eyelid, squamous cell carcinoma in situ, staining characteristics