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A 71-year-old female visited the Department of Dermatology at Tokyo Metropolitan Bokuto Hospital, complaining of a nodule in the face. She was diagnosed as Merkel cell carcinoma by a skin biopsy in another clinic, and referred to our hospital for operation. A physical examination revealed a dome-shaped reddish nodule, sized 1-cm in diameter, in the center of the left cheek. Cervical lymph nodes were not palpable

Epidermotropic pagetoid spread and squamous cell carcinoma in situ in the overlying epidermis of Merkel cell carcinoma