Volume 4, Issue 10, Pages (November 2018)

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Volume 4, Issue 10, Pages 996-999 (November 2018) A case of combined Merkel cell carcinoma and squamous cell carcinoma: Molecular insights and diagnostic pitfalls Leyre A. Falto Aizpurua, MD, Min Wang, PhD, Hiram A. Ruiz, MD, Jorge L. Sánchez, MD, May P. Chan, MD, Aleodor A. Andea, MD, Paul W. Harms, MD, PhD JAAD Case Reports Volume 4, Issue 10, Pages 996-999 (November 2018) DOI: 10.1016/j.jdcr.2018.08.004 Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 1 Clinical appearance of MCC on the left forehead, presenting as erythematous plaque. JAAD Case Reports 2018 4, 996-999DOI: (10.1016/j.jdcr.2018.08.004) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 2 Clinical lesion on left zygoma with biopsy-proven SCC, later found to have concurrent MCC upon excision. JAAD Case Reports 2018 4, 996-999DOI: (10.1016/j.jdcr.2018.08.004) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 3 Microscopic appearance of lesion on left zygoma. Breadloafed sections (original magnification x20, left) display MCC (yellow circles) highlighted by cytokeratin 20 (CK20) immunohistochemistry, adjacent to and intermingled with SCC (blue circles). Higher magnification (original magnification x400, top right) of the area with both components shows SCC with a subtle population of small round cells (area flanked by yellow arrows) that are challenging to identify because of intermingled lymphocytes. Cytokeratin-20 immunohistochemistry (lower right) confirms the presence of MCC. JAAD Case Reports 2018 4, 996-999DOI: (10.1016/j.jdcr.2018.08.004) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 4 Chromosomal copy number change by SNP array shows identical gains and losses in the MCC tumors from the forehead and zygoma (blue arrows), and a distinct pattern of gains and losses in the SCC from the zygoma (red arrows). JAAD Case Reports 2018 4, 996-999DOI: (10.1016/j.jdcr.2018.08.004) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions