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J.M. 21 y/o female c c: scalp mass

J.M. 21 y/o female c c: scalp mass. History of Present Illness. Slowly enlarging, firm, occasionaly tender mass on R parietoocipital area (3x3cm) Consult A: Hemangioma P: Excision. 14 years PTA. 2 mos PTA. Recurrence of slowly enlarging mass (5x5cm) Consult at UST OPD

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J.M. 21 y/o female c c: scalp mass

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  1. J.M. 21 y/o female cc: scalp mass

  2. History of Present Illness • Slowly enlarging, firm, occasionaly tender mass on R parietoocipital area (3x3cm) • Consult • A: Hemangioma • P: Excision 14years PTA

  3. 2 mos PTA • Recurrence of slowly enlarging mass (5x5cm) • Consult at UST OPD • Scalp X Ray • Ultrasound of neck ADMISSION

  4. PAST MEDICAL HISTORY • (-) HPN • (-) DM • (-) HPV infection • (-) Asthma • (-) Allergies • (-) PTB

  5. PERSONAL AND SOCIAL HISTORY • Mixed diet • Nonsmoker • Not an alcoholic beverage drinker

  6. FAMILY HISTORY • (+) HPN – mother • (+) DM – grandfather • (-) Asthma • (-) CA

  7. REVIEW OF SYSTEMS • (-) weight loss, weakness, fatigue • (-) Headache, dizziness, blurring of vision • (-) hearing loss, aural discharge, tinnitus • (-) epistaxis, nasal discharge, sinusitis • (-) hoarseness, mouth sores, dysphagia • (-) dyspnea, cough

  8. PHYSICAL EXAMINATION • Conscious, coherent, ambulatory, not in distress • BP: 120/80 PR 80bpm RR 18cpm T 36.5°C Wt. 60 kg Ht. 162cm • Warm moist skin, no active dermatoses • Pink palpebral conjunctivae, anicteric sclerae • No naso-aural discharge, non-congested turbinates, non-tender sinus, buccal mucosa, tonsils not enlarged, no bleeding gums • Supple neck, (-) palpable cervical Lymph Nodes, no thyromegaly

  9. Symmetric on chest expansion, (-) retractions, lungs resonant, clear breath sounds • Adynamic precordium, AB 5th LICS MCL, S1>S2 at the apex, S2>S1 at the base, no murmurs • Flat abdomen, no organomegaly, (-) rebound tenderness, no masses • (-) pallor, clubbing, petechiae, ecchymoses • Pulses ++ on all extremities

  10. Admitting Impression • Soft tissue tumor to consider recurrent hemangioma vs. granuloma

  11. Merkel’s Cell Carcinoma • Classified as a neuroendocrine malignancy of the skin. • Cutaneoussmall cell undifferentiated carcinoma • Incidence of 1200 per year in the US • Mortality rate of 33 % • National Cancer Institute. Fact Sheet MERKEL’S CARCINOMA. 2007 • Merkel Cell Carcinoma: More Deathsbut Still No Pathway to Blame Bianca Lemos and Paul Nghiem. Journal of Investigative Dermatology (2007)

  12. Discussion • Merkel’s cells located in the basal layer of the epidermis. • Grossly, the primary tumor presents as a small, red, pink, or blue-violet, non-ulcerated, painless, intradermal nodular mass often located in sun-exposed areas of the skin such as the head and neck

  13. Discussion • Neuroendocrine markers • Neuron-specific enolase • Chromogranin • Synaptopysin Merkel cell carcinoma, VirveKoljonen. World Journal of Surgical Oncology 2006

  14. American Joint Committee on Cancer • Stage I (primary lesion ≤ 2 cm) • Stage II (primary lesion > 2 cm). • Stage III (nodal involvement) • Stage IV disease(metastatic)

  15. Prognosis • Aggressive course with reported overall 5-year survival rates ranging from 30% to 64%. • Survival after a diagnosis of MCC is highly dependent on the stage at presentation. • 90 percent of recurrences occurring within three years of diagnosis • Merkel Cell Carcinoma: A Case Report and Literature Review. Oncology. Medical Journal of Islamic World Academy of Sciences 15:3, 91-94, 2005

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