In 2022, a seemingly routine dermatology visit turned into a life-changing moment for a gentleman in his early 70s. A Middle Eastern man with no personal or family history of skin cancer walked into our office concerned about a small, painless growth on his left knee. It had only been there for about five weeks but had noticeably increased in size.
On further review of his medical history, we discovered a critical detail—he had undergone a heart transplant two years prior and was on lifelong anti-rejection medications, making him immunosuppressed. This placed him at significantly higher risk for developing aggressive skin cancers.
On examination, the growth was a smooth, firm, reddish-purple nodule—non-tender and without any ulceration, almost like a keloid, which is an overgrown scar tissue. Given its rapid growth and unusual appearance, we performed a biopsy. The pathology results were unexpected: Merkel Cell Carcinoma (MCC), a rare but highly aggressive form of skin cancer.
Merkel Cell Carcinoma is a neuroendocrine cancer of the skin. It originates from Merkel cells, which are normally involved in touch sensation. Despite its small and sometimes innocent appearance, MCC is known for its aggressive behavior and high potential to spread (metastasize) to lymph nodes and distant organs.
• Approximately 3,000 to 3,500 new cases are diagnosed annually in the United States.
• While rare, cases have tripled over the past 20 years, likely due to increased awareness, improved diagnostics, and an aging population.
• MCC has a higher mortality rate than melanoma, with a five-year survival rate ranging from 60% for localized disease to less than 20% when distant metastasis is present.
• Individuals over the age of 65
• Fair-skinned individuals with significant sun exposure history
• People with weakened immune systems (including transplant recipients and those with chronic lymphocytic leukemia or HIV)
• However, as in this case, anyone can develop MCC, regardless of skin tone or prior history
• Asymptomatic (usually painless)
• Expanding rapidly
• Immune suppression
• Older than 50 years
• UV-exposed areas (head, neck, arms, but can occur anywhere—including the knee!)
• Biopsy for diagnosis (as performed in this case)
• Imaging studies: PET/CT scans to evaluate for lymph node involvement and distant metastases
• Sentinel lymph node biopsy to determine if cancer has spread to regional lymph nodes
• Immunohistochemical testing: Markers like CK20 (perinuclear dot staining) help confirm the diagnosis
• Treatment typically involves wide local excision, possible radiation therapy, and in some cases, immunotherapy with agents like avelumab or pembrolizumab for advanced disease
Beloved musician Jimmy Buffett, known for hits like Margaritaville, quietly battled Merkel Cell Carcinoma for four years before his passing in September 2023. Despite his diagnosis, he continued to perform and bring joy to fans worldwide. His case brought greater awareness to this rare but deadly cancer.
• You can view his final social media posts reflecting his positivity and love for life here: Jimmy Buffett Instagram.
This case serves as a powerful reminder: not all skin cancers look scary or feel painful. Some, like Merkel Cell Carcinoma, appear harmless at first glance but are incredibly aggressive beneath the surface.
If you notice a rapidly growing bump or unusual skin lesion—especially if it’s painless—don’t wait. Early detection saves lives. Stay sun-safe, stay vigilant, and when in doubt, let your dermatologist take a look.
Disclaimer: These are actual patient photos and cases from Dermatology Solutions and have been published solely for educational purposes with written consent from the patients. Reproduction, distribution, or copying of any content or images is strictly prohibited without the explicit written consent of Dermatology Solutions.