Intracranial Spread of Merkel Cell Carcinoma through Intact Skull

• Published in: Annals of otology, rhinology & laryngology rhinology & laryngology, 2004-09, Vol.113 (9), p.683-687
• Main Authors: Barkdull, Gregory C., Healy, John F., Weisman, Robert A.
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Bone Marrow Neoplasms - diagnosis; Bone Marrow Neoplasms - pathology; Bone Marrow Neoplasms - secondary; Bone Marrow Neoplasms - surgery; Brain Neoplasms - diagnosis; Brain Neoplasms - pathology; Brain Neoplasms - secondary; Brain Neoplasms - surgery; Carcinoma, Merkel Cell - diagnosis; Carcinoma, Merkel Cell - pathology; Carcinoma, Merkel Cell - secondary; Carcinoma, Merkel Cell - surgery; Cerebral Cortex - pathology; Cerebral Cortex - surgery; Chemotherapy, Adjuvant; Combined Modality Therapy; Craniotomy; Disease Progression; Dura Mater - pathology; Dura Mater - surgery; Fatal Outcome; Frontal Bone - pathology; Frontal Bone - surgery; Humans; Magnetic Resonance Imaging; Male; Medical sciences; Meningeal Neoplasms - diagnosis; Meningeal Neoplasms - pathology; Meningeal Neoplasms - secondary; Meningeal Neoplasms - surgery; Middle Aged; Neoplastic Cells, Circulating - pathology; Otorhinolaryngology. Stomatology; Radiotherapy, Adjuvant; Scalp - pathology; Scalp - surgery; Skin Neoplasms - diagnosis; Skin Neoplasms - pathology; Skin Neoplasms - surgery; Skull Neoplasms - diagnosis; Skull Neoplasms - pathology; Skull Neoplasms - secondary; Skull Neoplasms - surgery; Tomography, X-Ray Computed
• ISSN: 0003-4894; 1943-572X
• DOI: 10.1177/000348940411300901

We report an unusual case of Merkel cell carcinoma presenting as a frontal scalp mass with apparent invasion into underlying brain parenchyma through grossly intact calvaria. Despite wide local excision, craniectomy, intracranial tumor resection, and postoperative adjuvant irradiation, widespread systemic metastases resistant to chemotherapy developed, and the patient died 9 months after surgery. This case report confirms that Merkel cell carcinoma of the head and neck, already known to be an aggressive tumor, has the capacity for rapid intracranial extension. We propose that in this case, the mechanism of intracranial metastasis was via communicating veins rather than through bone destruction or systemic metastasis. Appropriate preoperative imaging should be carried out to define the extent of this tumor when it is adjacent to the skull. We found contrast-enhanced magnetic resonance imaging to be superior to computed tomography for defining soft tissue extent and marrow space involvement within underlying bone.