Abstract: FR-PO1290
Merkel-Cell Carcinoma Requiring Enucleation in a Kidney Transplant Recipient
Session Information
- Onconephrology: Diagnostic Dilemmas, Therapy-Related Toxicities, and Clinical Cases
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1600 Onconephrology
Authors
- Touma, Mary-Joe, South Texas Health System, Edinburg, Texas, United States
- Medina De Leon, Manolo, South Texas Health System, Edinburg, Texas, United States
- EL-Najjar, Yassin, South Texas Health System, Edinburg, Texas, United States
- Alsharif, Mhd Nezar, South Texas Health System, Edinburg, Texas, United States
- Alsabbagh, Mourad, South Texas Health System, Edinburg, Texas, United States
Introduction
Merkel cell carcinoma (MCC) is a rare and aggressive type of skin cancer with high rates of local recurrence and nodal involvement. Its incidence is higher in solid organ transplant recipients. Involvement of the eyes is uncommon and cases that require enucleation are rarely reported.
Case Description
A 55-year-old woman with end-stage renal disease due to hypertension and congenital renal hypoplasia received a deceased donor kidney transplant in 2022. She was maintained on tacrolimus, prednisone, and mycophenolate. In 2024, she presented with a painless cyst-like lesion on her left zygomatic area. The lesion was excised without pathology (a), but recurred within 1 week (b), rapidly extending toward the eye (c-f). PET scan revealed a hypermetabolic left periorbital lesion, without metastasis. A biopsy confirmed MCC. An MRI 8 weeks later showed progression to a lobular periorbital mass extending to the anterior orbital rim. Due to the aggressive local growth, the patient underwent a wide local excision, left orbital enucleation, cervical lymph node dissection, and reconstruction with a split-thickness skin graft from the thigh. Surgical margins and lymph nodes were tumor-free. Given the location of the lesion, she completed six weeks of radiotherapy. Her immunosuppressive regimen was modified from mycophenolate to sirolimus. She was followed clinically and radiographically for a year without recurrence or metastasis.
Discussion
Periocular MCC is rare and aggressive, especially among kidney transplant patients. This case emphasizes the need for early biopsy of atypical lesions in immunocompromised patients and highlights the risks of delayed diagnosis as well as the challenges in maintaining allograft function while managing malignancy. Timely diagnosis and multidisciplinary management are essential to improve prognosis.
(a-f) Lesion progression within 8 weeks