Merkel cell carcinoma presenting in a young patient as a forme fruste of variant epidermodysplasia verruciformis  Christian R. Halvorson, MD, Susannah McClain, MD, Peter Rady, MD, PhD, Steven Tyring, MD, PhD, MBA, Anthony A. Gaspari, MD  Journal of the American Academy of Dermatology  Volume 65, Issue 3, Pages 667-669 (September 2011) DOI: 10.1016/j.jaad.2010.06.007 Copyright © 2010 American Academy of Dermatology, Inc. Terms and Conditions

Fig 1 A. Histopathology revealed an ill-defined dermal tumor composed of mid-sized cells with scant cytoplasm and fine chromatin pattern, infiltrating subcutaneous adipose tissue. B, Lesion was found to stain positively with cytokeratin (CK)-20, distinguishing it from small cell carcinomas from other sites. Chromogranin and synaptophysin staining was also positive, whereas CK-7, thyroid transcription factor-1 (TTF-1), and S-100 were negative. Journal of the American Academy of Dermatology 2011 65, 667-669DOI: (10.1016/j.jaad.2010.06.007) Copyright © 2010 American Academy of Dermatology, Inc. Terms and Conditions

Fig 2 A and B, Detection of Merkel cell polyomavirus (MCPyV) DNA using polymerase chain reaction (PCR) in a young patient with Merkel cell carcinoma (MCC). PCR products were analyzed on 2.0% agarose gel electrophoresis and visualized on an ultraviolet transilluminator. A, β-Globin reference gene PCR assay; lanes; M: ϕX174RF DNA marker, 1: MCC, 2: MCPyV negative control DNA extracted from peripheral blood mononuclear cells (PBMC) (Promega Co, Madison, WI), 3: reagent control. Expected β-globin 268 base pair (bp) PCR fragments can be seen in lanes 1 and 2. B: MCPyV-PCR assay; lanes; M: ϕX174RF DNA marker (Promega Co), 1: MCC, 2: MCPyV negative control DNA extracted from PBMC (Promega Co), 3: reagent control. Expected 335 bp PCR product of MCPyV can be seen in lane 1. C, Patient’s family tree. Her parents (A and B) are both healthy and do not exhibit warts or skin cancer. Her brother (G), who is 38 years old, has numerous flat warts (human papillomavirus [HPV] types 15 and 17) and multiple nonmelanoma skin cancers on sun-exposed skin. His wife (H) is healthy, but both of their two sons (L and M, ages 5 and 11 years), have numerous flat warts (HPV types 5 and 17) on their face, scalp, arms, and trunk, with an apparent autosomal dominant pattern of inheritance. Patient’s other brother (E) and two nephews (J and K) are healthy, without warts or skin cancer. Study of patient’s brother’s genomic DNA for mutations in EVER1 or EVER2 did not reveal any detectable mutations.3 EDV, Epidermodysplasia verruciformis. Journal of the American Academy of Dermatology 2011 65, 667-669DOI: (10.1016/j.jaad.2010.06.007) Copyright © 2010 American Academy of Dermatology, Inc. Terms and Conditions