An 85-year-old white man presented with a 3-month history of several flesh-colored, nontender, intracutaneous nodules involving his left pectoral region (Figure). Two years earlier, he had undergone a left axillary dissection followed by radiation and chemotherapy for a Merkel-cell carcinoma (MCC) originating on the dorsum of his left hand. He subsequently did well until the current skin lesions appeared. Biopsy of one of the new nodules showed findings consistent with MCC.

Points to remember: MCC is a rare neuroendocrine dermal tumor that presents as nontender, violaceous or erythematous, subcutaneous nodules in sun-exposed areas of the skin. It typically affects the elderly, and has an aggressive clinical course and the propensity for metastasis and recurrence. Surgical excision is the primary treatment for nonmetastatic disease, whereas radiation with chemotherapy best treats metastatic disease.

Diagnosis: Merkel-cell carcinoma.