Answer of May 2004

Clinical History:

A 57-year-old gentleman presented with progressive left orbital swelling for 2 months. He has unremarkable past health and is a non-smoker.

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Diagnosis:

Merkel cell carcinoma (MCC)

Discussion:

The lesion probably first arising from the skin of the left orbit. CT scan showed large soft tissue mass in L orbit with erosion of skull base and involvement of L ethmoid sinus, as well as intracranial extension into the L anterior intracranial fossa. For this gentleman, the disease was too advanced for curative resection. He was treated with palliative chemotherapy using the EP regimen but with poor disease response. Palliative radiotherapy was then given.
There is bilateral inferior rib notching from 5th to 10th ribs.