A year ago a 2.5 cm nodule grew on this 84-year-old farmer's right arm after appearing as a purple macule a month earlier. A skin biopsy showed a Merkel cell carcinoma. He had a history of extensive sun exposure but no skin cancers although he was subsequently diagnosed with several non-melanoma skin cancers. At diagnosis he was noted to have a right axillary lymph node, and he was treated with wide excision and irradiation. The first recurrence developed 6 months later which was treated with local excision and radiation. The second recurrence was noted last month along with a basal cell carcinoma in the right alar groove and squamous cell carcinoma on the back. He refused further treatment.
2.5 cm diameter purple dome shaped well demarcated nodule with overlying scale and crust