Case Report: The role of nodal staging in periocular merkel cell carcinoma - lessons from three cases.

Merkel cell carcinoma (MCC) of the eyelid is a rare, aggressive cutaneous neuroendocrine malignancy. We report three patients with upper eyelid MCC managed at a single ophthalmology centre. Patients were aged 74, 78 and 65 years; two were female and one male. All underwent wide local excision and complex eyelid reconstruction using Cutler-Beard and adjunctive flap techniques. Outcomes differed substantially: the patient who underwent neither nodal staging nor adjuvant therapy developed parotid metastases within two months and died at 4.5 months. The two patients in whom nodal staging was performed remain disease-free at 35 and 13 months, respectively, despite also not receiving adjuvant radiotherapy. These cases illustrate the diagnostic challenge of periocular MCC and are consistent with guideline recommendations for nodal staging, although a series of three patients cannot separate the effect of staging from that of performance status.