No abstract

Merkel cell carcinoma (MCC) is a rare but deadly skin cancer, observed classically in the sun-damaged skin of older, white males. The cancer is characterized by rapid growth as well as high morbidity and mortality. In this article, we detail an atypical presentation of MCC in an African-American patient being treated with prednisone, methotrexate, and adalimumab for rheumatoid arthritis. Initially presenting as a subcutaneous nodule, the tumor in our patient was misdiagnosed first as an abscess and treated accordingly. Only after the subcutaneous mass failed to resolve with antibiotics as well as repeated incision and drainage was a biopsy performed, which yielded the final diagnosis. In the text, we detail the patient’s symptomatology as well as steps that eventually lead to diagnostic confirmation. Our case demonstrates the importance of heightened clinical suspicion for MCC in immunosuppressed patients with unexplained subcutaneous nodules. Prompt diagnosis is crucial for positive outcomes; therefore, we aim to provide information that may aid in identification of MCC tumors in future patients. With the increasing use of biologic agents such as adalimumab to treat rheumatic disease, the literature is demonstrating an increasing incidence of previously “rare” malignancies such as MCC. It is crucial for physicians to convey these risks when initiating a patient on chronic immunosuppressive therapy and to provide routine surveillance for MCC and other complications.

Dermatology faces a worsening scarcity of providers, especially since the onset of the COVID-19 pandemic. With lengthening waiting periods for skin cancer screening examinations, there is a distinct need for alternatives to in-person evaluation. Delayed diagnosis is associated with poorer outcomes, especially in melanoma. Teledermatology has the potential to prevent the increased morbidity and mortality associated with late-stage diagnosis, especially when utilized with dermoscopy. In the literature, this novel field of 'teledermoscopy' has exhibited accuracy and reliability comparable to face-to-face visits, and it is a promising alternative intervention for those who require triaging or for patients who are unable to access in-person care (rural, underserved populations). Although early data are promising, formal guidelines for acquisition and interpretation of dermatoscopic images must be established before wider implementation is possible. With standardization, use at home or in primary care offices might relieve some of the pressure on an overburdened dermatologic care system and help patients requiring urgent care to be seen more expediently.