SECOND OPINION
Multidisciplinary Consultations on Challenging Cases
The University of Colorado Health Sciences Center holds weekly second opinion conferences focusing on cancer cases that represent most major cancer sites. Patients seen for second opinions are evaluated by an oncologist. Their history, pathology, and radiographs are reviewed during the multidisciplinary conference, and then specific recommendations are made. These cases are usually challenging, and these conferences provide an outstanding educational opportunity for staff, fellows, and residents in training.
The second opinion conferences include actual cases from genitourinary, lung, melanoma, breast, neurosurgery, and medical oncology. On an occasional basis, ONCOLOGY will publish the more interesting case discussions and the resultant recommendations. We would appreciate your feedback; please contact us at second.opinion@uchsc.edu.
E. David Crawford, MD
Al Barqawi, MDGuest EditorsUniversity of Colorado Health Sciences Center
Univeristy of Colorado Cancer Center Denver, Colorado
The patient is an elderly woman with rheumatoid arthritis who was evaluated in our multidisciplinary cutaneous oncology clinic for a new diagnosis of Merkel cell carcinoma.
History
This 74-year-old Caucasian female noted a red nodule on her left forearm approximately 4 months prior to diagnosis. She stated that the lesion started as a small, raised papule and slowly grew in size. Because the lesion was enlarging, the patient sought evaluation by her dermatologist. A biopsy was performed and revealed Merkel cell carcinoma. Positron-emission tomography/computed tomography (PET/CT) scan was performed and did not show evidence of metastatic disease. The patient subsequently underwent wide excision with concurrent sentinel lymph node evaluation. The reexcision specimen revealed an undifferentiated small-cell carcinoma most consistent with Merkel cell carcinoma, with clear margins. One sentinel lymph node harvested from the left axilla was negative for metastatic disease.
The patient then presented for a second opinion regarding further treatment options and follow-up plans. Of note, the patient has a 20-year history of rheumatoid arthritis. She has been treated with oral steroids for approximately 15 years, and at the time of her initial evaluation was on 2 mg of prednisone daily. She was also being treated with infliximab (Remicade) for her rheumatoid arthritis for approximately 2 years prior to her diagnosis of Merkel cell carcinoma.
Her past medical history is also significant for hypertension, which is well controlled on low-dose lisinopril. Her family history is significant for a daughter who died of leukemia in her early 30s. There is no family history of merkel cell carcinoma or melanoma. Her review of systems was pertinent for arthritis pain, mainly in her wrists. The rest of her review of systems was unremarkable.
Physical Exam
FIGURE 1
Exophytic Tumor on Left Forearm
Internal server error
