Unusual association of Merkel-cell carcinoma and hepatocellular carcinoma in alcohol and hepatitis C virus-related cirrhosis: Casual or causal relation?

Abstract

Background: Merkel-cell carcinoma (MCC) is a rare and highly aggressive skin cancer. The estimated annual incidence rate of MCC is increasing, and the mortality rate is considerably higher worse than that of cutaneous melanoma. The risk of MCC is higher in immunosuppressed patients and in those with other malignancies. Case representation: The present report is the first description of MCC associated with hepatocellular carcinoma in an immunocompetent patient with alcohol and hepatitis C virus (HCV)-related liver cirrhosis. Conclusions: This case supports the hypothesis of HCV systemic oncogenicity, suggested by previous reports describing an association of this virus with lympho-proliferative disease, gastrointestinal, kidney, and breast malignancies, even though a causal relation or mechanism have not been clearly established. Further studies are needed to clarify whether the impairment of immune system associated with advanced cirrhosis may also play a role, by allowing opportunistic viruses to initiate oncogenic pathways. This paper finally highlights the importance of the screening for skin and systemic disorders in patients with chronic hepatitis C.