Abstract
BACKGROUND: Merkel cell carcinoma (MCC) is a rare and aggressive skin cancer with high incidence in older and immunocompromised patients. Its occurrence in the nasal dorsum is extremely rare and poses significant diagnostic and therapeutic challenges. CASE SUMMARY: We report the case of a 65-year-old woman with diabetes mellitus and hypertension who presented with a dorsal nasal mass. The initial differential diagnosis favored hemangioma-based clinical examination on imaging. Histopathological examination after excision revealed MCC, necessitating a complex management strategy. A 3 cm × 2 cm nasal mass, initially suspected to be a hemangioma, was excised but revealed MCC with positive margins. Positron emission tomography-computed tomography confirmed metastatic cervical lymphadenopathy. The patient underwent bilateral neck dissection, revealing metastases in seven nodes. Residual activity was treated with radiation therapy, leading to a favorable response after 6 months. CONCLUSION: This case highlights the importance of considering MCC in the differential diagnosis of nasal masses, and integrated management.