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Merkel cell carcinoma (MCC) is a rare neuroendocrine malignancy of the skin that is highly aggressive and often metastasizes early. MCC is diagnosed based on histopathological findings and is most commonly treated with surgical resection, which may be accompanied by chemotherapy and/or radiation. This report describes a 55-year-old male patient with the history of recurrent malignant melanoma of the right pinna and subsequent excision. Three years following the excision of melanoma, he presented with a lesion to the right forehead as well as a right-sided neck mass that were found to be metastatic Merkel cell carcinoma.

Background: Factitious disorder (FD) imposed on self is a psychiatric disorder characterized by the intentional feigning of symptoms or the self-inflicted production of symptoms in the absence of an obvious external reward. Case: This report describes a severe case of FD imposed on self in a 31-year-old male who frequently presented to several regional Emergency Departments with intentional ingestion of foreign objects, ultimately requiring 32 esophagogastroduodenoscopy (EGD) and 28 gastroscopy procedures over two years. Significant history of frequent suicide attempts via medication overdose and clinical suspicion of drug-seeking behavior complicated the case. Motivating factors for the patient’s behavior, suicidality in FD, and thepatient’s treatment and outcome to date will be discussed. Conclusion: There is no well-established treatment for FD documented in the literature. High-quality studies and additional reports of FD could help clinicians when managing such a challenging diagnosis.