Challenges in Managing Brain Metastases From Merkel Cell Carcinoma in an Immunosuppressed Patient - Case Report

Sep 29, 2026

Uploaded by nayy☆

Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine skin tumor with high metastatic potential and poor prognosis. Distant CNS involvement is uncommon and often delays recognition and treatment. The report describes a 58-year-old immunosuppressed man with progressive weakness and disorientation; imaging showed a frontal brain lesion and distant lymphadenopathy without an obvious skin primary. Biopsy confirmed MCC, and interdisciplinary care was complicated by infection, systemic deterioration, and death. The case emphasizes early detection and intensive multidisciplinary management despite limited options.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Abstract

Introduction

Case Presentation

Imaging and findings

Diagnosis and initial management

Outcome and complications

Review began 09/27/2025 Review ended 12/03/2025 Published 12/05/2025 © Copyright 2025 Rebelo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98538 Open Access Case Report Challenges in Managing Brain Metastases From Merkel Cell Carcinoma in an Immunosuppressed Patient: A Case Report Francisco Rebelo 1, Teresa Morais Pinheiro 1, João Pimentel 2, Carlos Pontinha 2, Julia Gerhardt 1 1. Neurosurgery, Unidade Local de Saúde de São José, Lisbon, PRT 2. Pathology, Unidade Local de Saúde de São José, Lisbon, PRT Corresponding author: Francisco Rebelo, [franciscoalmeidarebelo@gmail.com](franciscoalmeidarebelo@gmail.com) Abstract Merkel cell carcinoma (MCC) is a rare but aggressive neuroendocrine tumor with high rates of metastasis and poor prognosis. While MCC commonly metastasizes to the lymphatic system, distant central nervous system (CNS) involvement is unusual, often complicating early detection and treatment. We describe the case of a 58-year-old male with multiple comorbidities who presented with progressive left-sided weakness and disorientation. Imaging revealed a right frontal lesion with mass effect, and further scans identified aniliac and inguinal lymphadenopathy without a primary skin lesion. The initial inguinal lymph node biopsy was inconclusive, prompting surgical resection of the brain lesion. Histopathology confirmed neuroendocrine carcinoma with CK20 dot-like positivity, consistent with MCC. Despite interdisciplinary management, the patient experienced multiple complications, including a respiratory infection and progressive systemic deterioration, ultimately succumbing to septicemia. MCC with CNS metastasis is a rare and highly lethal condition. This case underlines the importance of early recognition and aggressive multidisciplinary management for potential improvement in prognosis, despite limited therapeutic options. Categories: Neurosurgery, Oncology, Dermatology Keywords: brain parenchyma metastases, immunosuppresion, merkel cell carcinoma (mcc), merkel cell polyomavirus, neuro-oncology surgery Introduction Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine tumor of the skin [1,2] . It is considered the most lethal skin cancer, with a five-year disease-specific survival rate of just 64%[2,3] . Although the estimated incidence of MCC is approximately 0.79 new cases per 100,000 people per year, it has tripled over the last two decades, likely due to an aging population, but also to improved diagnostic methods and increased recognition of the disease [2-5]. It is locally aggressive, with a high rate of local recurrence, regional lymph node involvement, and metastasis [3,6] . Between 21% and 50% of patients develop distant metastatic disease [3,7], mainly through the lymphatic system [8-10], with about 50% of the patients having local lymph node involvement at primary diagnosis [9] . Other common sites of distant metastases are the skin, mediastinum, liver, lung, and bone [3] . Central nervous system (CNS) involvement in MCC is rather unusual and may occur via hematogenous spread, lymphatic routes, direct extension, or dissemination through cerebrospinal fluid [3, 11] . Due to its rarity, CNS involvement is often detected late, and treatment protocols are not well established [4,8] . Furthermore, brain metastases are associated with a poor prognosis, with a median overall survival of approximately two years without surgical treatment [11]. Case Presentation A 58-year-old obese (BMI = 35 .5 kg/m²), Caucasian male with a medical history of chronic obstructive pulmonary disease (COPD), psoriasis, and type 2 diabetes mellitus, status post renal and pancreatic transplants performed in 2015 for diabetic nephropathy and pancreati

FAQs

Why is CNS metastasis from Merkel cell carcinoma difficult to detect?

CNS involvement is unusual in MCC, so it is often identified late. Scarce evidence and no well-established treatment protocols further complicate timely management.

What led to confirmation of Merkel cell carcinoma in this case?

A right frontal brain lesion was surgically resected after an inconclusive inguinal lymph node biopsy. Histopathology showed neuroendocrine carcinoma with CK20 dot-like positivity consistent with MCC.

What complications occurred despite interdisciplinary management?

The patient developed multiple complications, including a respiratory infection and progressive systemic deterioration. He ultimately succumbed to septicemia.

Sep 29, 2026

Uploaded by nayy☆