Background Paraneoplastic syndromes are commonly associated with neuroendocrine cancers, such as small cell lung cancer. Objectives We examined the association of paraneoplastic syndromes in Merkel cell carcinoma (MCC), a rare neuroendocrine skin cancer. Methods We identified paraneoplastic syndromes associated with MCC based on chart review of a Seattle-based repository and also examined the incidence of MCC-associated hyponatremia in an independent cohort within Kaiser Permanente Northern California (KPNC). Results Eight paraneoplastic syndrome (PNS) cases were identified from the Seattle repository. Three distinct PNS types were observed: cerebellar degeneration (one case), Lambert-Eaton myasthenic syndrome (two cases), and malignancy-associated hyponatremia (five cases). Moreover, the incidence of severe hyponatremia (serum sodium <125 mmol/L) coincident with MCC was identified among 4.3% (9 of 211) MCC patients in the KPNC cohort. Limitations We did not have access to complete medical records on all patients so it was not possible to determine the prevalence of paraneoplastic syndromes in MCC. Conclusions MCC can be associated with paraneoplastic syndromes similar to those found in other neuroendocrine cancers. Clinicians should be aware of these presentations as paraneoplastic syndromes often precede the identification of the underlying malignancy and usually resolve with appropriate treatment of the cancer.

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Direct closure without undermining is a simple, reproducible technique for repair of lower lip vermilionectomy defects and leads to excellent cosmetic, functional and sensory results in the majority of patients.

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