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Volume 4, Issue 10, Pages 1004-1006 (November 2018) Talimogene laherparepvec in combination with pembrolizumab leads to a complete response in a patient with refractory Merkel cell carcinoma Kristi M. Lara, MSPAS, MPH, PA-C, Gino K. In, MD, MPH, George R. Matcuk, MD, Arjun Mehta, MD, James S. Hu, MD JAAD Case Reports Volume 4, Issue 10, Pages 1004-1006 (November 2018) DOI: 10.1016/j.jdcr.2018.10.003 Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 1 18F-fluorodeoxyglucose positron emission tomography/CT fusion image shows a hypermetabolic right pelvic lymph node (arrow) lateral to the bladder, confirmed to be an MCC lymph node metastasis at subsequent CT-guided biopsy. JAAD Case Reports 2018 4, 1004-1006DOI: (10.1016/j.jdcr.2018.10.003) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 2 CT of the abdomen/pelvis shows an enlarged left para-aortic lymph node (arrow), confirmed to be an MCC lymph node metastasis at subsequent CT-guided biopsy. JAAD Case Reports 2018 4, 1004-1006DOI: (10.1016/j.jdcr.2018.10.003) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 3 Hematoxylin-eosin section shows a histologically normal epidermis and an intradermal tumor growing in a vaguely nodular pattern. JAAD Case Reports 2018 4, 1004-1006DOI: (10.1016/j.jdcr.2018.10.003) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 4 Axial short tau inversion recovery (STIR) magnetic resonance image shows a 5-cm bilobed nodule of the posterior aspect of the popliteal fossa (arrows), confirmed to be an MCC metastasis at subsequent ultrasound-guided biopsy. JAAD Case Reports 2018 4, 1004-1006DOI: (10.1016/j.jdcr.2018.10.003) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 5 Axial T1 fat saturation postcontrast magnetic resonance image shows near-complete resolution of the previously seen popliteal nodule (arrow). JAAD Case Reports 2018 4, 1004-1006DOI: (10.1016/j.jdcr.2018.10.003) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions