Abstract
Merkel cell carcinoma (MCC) is a rare, aggressive skin cancer of neuroendocrine origin that has been known to recur and metastasize within the first three years of initial diagnosis. MCC is typically diagnosed with clinicopathologic correlation of a red-purple nodule or flesh colored papule on sun-damaged skin and characteristic immunohistochemical staining. We present a case of a 66-year-old White man who was found to have metastatic MCC over nine years after the initial stage one tumor was diagnosed and treated with Mohs micrographic surgery (MMS) and radiation therapy. This case highlights the importance of defining prognostic biomarkers for each patient with MCC and consideration of extended surveillance beyond the current recommended three years. Clinicians should also be attentive when counseling patients to explain that the risk of late metastasis, although low, is still possible.