PDF(Pubmed)
Abstract：
Merkel cell carcinoma (MCC) is a rare but deadly skin cancer, observed classically in the sun-damaged skin of older, white males. The cancer is characterized by rapid growth as well as high morbidity and mortality. In this article, we detail an atypical presentation of MCC in an African-American patient being treated with prednisone, methotrexate, and adalimumab for rheumatoid arthritis. Initially presenting as a subcutaneous nodule, the tumor in our patient was misdiagnosed first as an abscess and treated accordingly. Only after the subcutaneous mass failed to resolve with antibiotics as well as repeated incision and drainage was a biopsy performed, which yielded the final diagnosis. In the text, we detail the patient\'s symptomatology as well as steps that eventually lead to diagnostic confirmation. Our case demonstrates the importance of heightened clinical suspicion for MCC in immunosuppressed patients with unexplained subcutaneous nodules. Prompt diagnosis is crucial for positive outcomes; therefore, we aim to provide information that may aid in identification of MCC tumors in future patients. With the increasing use of biologic agents such as adalimumab to treat rheumatic disease, the literature is demonstrating an increasing incidence of previously \"rare\" malignancies such as MCC. It is crucial for physicians to convey these risks when initiating a patient on chronic immunosuppressive therapy and to provide routine surveillance for MCC and other complications.
摘要：
默克尔细胞癌（MCC）是一种罕见但致命的皮肤癌，典型地观察到在阳光下受损的老年人皮肤，白人男性。癌症的特征在于快速生长以及高发病率和死亡率。在这篇文章中,我们详述了一名接受泼尼松治疗的非裔美国患者的MCC非典型表现，甲氨蝶呤,和阿达木单抗治疗类风湿性关节炎.最初表现为皮下结节，我们患者的肿瘤首先被误诊为脓肿并进行了相应的治疗。只有在皮下肿块用抗生素以及反复切开和引流失败后，才进行活检。这产生了最终的诊断。在文本中，我们详细介绍了患者的症状以及最终导致诊断确认的步骤。我们的病例表明，在不明原因的皮下结节的免疫抑制患者中，对MCC的临床怀疑增加的重要性。及时诊断对于积极的结果至关重要；因此，我们的目标是提供可能有助于识别未来患者MCC肿瘤的信息.随着阿达木单抗等生物制剂治疗风湿性疾病的使用越来越多，文献表明，以前的“罕见”恶性肿瘤如MCC的发病率正在增加。对于医生来说，当患者开始接受慢性免疫抑制治疗并提供MCC和其他并发症的常规监测时，传达这些风险至关重要。
