Head and Neck Pathology

, Volume 12, Issue 2, pp 279–285 | Cite as

Merkel Cell Carcinoma of the Buccal Mucosa and Lower Lip

  • Mohammed N. Islam
  • Hardeep Chehal
  • Molly Housley Smith
  • Sarah Islam
  • Indraneel Bhattacharyya
Case Report


Merkel cell carcinoma (MCC) is an uncommon relatively aggressive neuroendocrine dermal neoplasm first described in 1972 as a tumor of the sun exposed skin. Although most MCC affect the skin of the head and neck, rare primarily oral mucosal cases have been documented. Merkel cells are nondendritic neuroendocrine cells that are found not only in the skin but also the oral mucosa and give rise to MCC. Neuroendocrine cells may be found as aggregates in organs or as diffuse or isolated cells within organs and their epithelial lining. They contain peptide hormones and biogenic amines and occur in two forms: dendritic, which are not associated with nerve fibers and non-dendritic, which are associated with nerve fibers. Merkel cells as well as MCC express simple epithelium-type Cytokeratins (8, 18, 19, 20), neurosecretory substances; chromogranin A, synaptophysin, neuron-specific enolase (NSE), adhesion molecules, and villin (intermediate filament). Though weakly, they also express neural markers such as S-100 protein. Cytokeratin 20, and Cluster of differentiation 56, are the two key diagnostic markers for Merkel cells and MCC. Etiology includes UV radiation, the recently described Merkel cell polyomavirus, and long term systemic immunosuppression. The cutaneous and mucosal variants of MCC are considered aggressive tumors with a high risk for local recurrence and metastasis and should be considered in the differential diagnosis of head and neck mucosal lesions. We present two cases of primary Merkel cell carcinoma, one on the buccal mucosa and the other on the lower lip, and discuss the salient histologic, immunohistochemical and clinical features.


Merkel cell carcinoma Dermal neoplasm Neuroendocrine tumor Trabecular cell carcinoma 



No funding was needed.

Compliance with Ethical Standards

Conflict of interest

Mohammed N. Islam, Hardeep Chehal, Molly Housley Smith, Sarah Islam and Indraneel Bhattacharyya declares that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Mohammed N. Islam
    • 1
  • Hardeep Chehal
    • 2
  • Molly Housley Smith
    • 1
  • Sarah Islam
    • 3
  • Indraneel Bhattacharyya
    • 1
  1. 1.Department of Oral and Maxillofacial Surgery and Diagnostic SciencesUniversity of Florida College of DentistryGainesvilleUSA
  2. 2.Department of Oral Diagnostic SciencesCreighton University, School of DentistryOmahaUSA
  3. 3.Indiana University School of MedicineEvansvilleUSA

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