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Comparison of periocular Merkel cell carcinoma diagnosis and management by ophthalmologists and non-ophthalmologist physicians

Eye volume 39, pages 2492–2494 (2025)Cite this article

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Merkel cell carcinoma (MCC) is an uncommon, high-grade cutaneous neuroendocrine carcinoma with a very high rate of metastasis when compared to other non-melanoma skin cancers (NMSC) [1]. Patients typically present with an asymptomatic, rapidly expanding, solitary, violaceous papule or nodule [2, 3]. Eyelid MCC are frequently mistaken for chalazia, cysts, or basal cell carcinoma at initial presentation [1, 4, 5]. Initial mismanagement resulting from misdiagnosis may include topical steroid usage or surgical drainage—both of which delay correct diagnosis and appropriate treatment [5, 6]. Timely diagnosis is important, as MCC has the potential to be locally aggressive and can metastasize to lymph nodes or to distant sites.

This retrospective, cross-sectional study of all patients with a histologically proven diagnosis of periocular MCC at Massachusetts Eye & Ear (MEE) between January 1, 2010 and December 31, 2022, aimed to identify risk factors for initial misdiagnosis or mismanagement of MCC. Patient records were reviewed, and data were manually collected. For patients who had incomplete data in the electronic medical record, all usable data elements were incorporated into the analysis. Statistical analyses were conducted in Python using SciPy version 1.10.0. Two sample t-tests were used to determine statistical significance of lengths of time to MCC management with a significance level of α = 0.05.

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Authors and Affiliations

  1. University of Massachusetts Chan Medical School, Worcester, MA, USA

    Kai-Lou C. Yue

  2. Massachusetts Eye and Ear, Department of Ophthalmology, Boston, MA, USA

    Kai-Lou C. Yue, Natalie Wolkow, Anna M. Stagner & Grayson W. Armstrong

Authors
  1. Kai-Lou C. Yue
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  2. Natalie Wolkow
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  3. Anna M. Stagner
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  4. Grayson W. Armstrong
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Contributions

KCY and GWA were responsible for research design, data acquisition, data analysis and interpretation, and manuscript preparation. NW and AMS were responsible for data acquisition, data analysis, and manuscript preparation.

Corresponding author

Correspondence to Grayson W. Armstrong.

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Competing interests

GWA has consulted for and received compensation from Ocular Technologies Inc, McKinsey & Company, Kriya Therapeutics, Xenon Ophthalmics, Chart Biopsy, Dynamed, Optomed, and Genentech. KCY, NW, and AMS declare no potential conflict of interest.

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Yue, KL.C., Wolkow, N., Stagner, A.M. et al. Comparison of periocular Merkel cell carcinoma diagnosis and management by ophthalmologists and non-ophthalmologist physicians. Eye 39, 2492–2494 (2025). https://doi.org/10.1038/s41433-025-03904-0

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