BMC Cancer 2005, 5:106 http://www.biomedcentral.com/1471-2407/5/106 FHiigstuorpeat3hology showing Merkel cells arranged in rosettes with mitoses present (haematoxylin eosin; × 100) Histopathology showing Merkel cells arranged in rosettes with mitoses present (haematoxylin eosin; × 100). lymphadenopathy on the second recurrence was unex- pectedly due to lymphoma and this complicated the deci- sion on the modality of treatment and further management of the patient. Fortunately both tumors responded to field radiation therapy and on the last fol- low up there was no evidence of deterioration of the leukemic status or MCC metastatic spread. Probably, a wider excision during the initial diagnosis of the skin tumor (with at least a 1.5 cm margin) [13], should have led to an earlier regression of MCC. However, Gillenwater et al [25] demonstrated no difference in outcome based on margins < 1 cm, 1 to 2 cm and > 2 cm. On the other sider, considering the agressiveness of MCC, radiation therapy should have been involved during the second recurrence, although lymphadenopathy was then positive only for CLL related lymphoma. However, as the subse- quent lymph node recurrence of MCC occurred only one month later, it raises the possibility that it was already present when the biopsy was performed and the biopsy result was falsely reassuring. Studies have shown that the best outcome is obtained in patients with regional disease following lymph node dis- section with or without subsequent radiation. Our case report highlights the importance of aggressive treatment of MCC with elective lymph node dissection at presenta- tion, even if the coexisting lymphadenopathy could be related to the coexisting CLL Certainly, on the background of CLL, clinicopathological features and treatment modalities are more complicated and effectiveness depends on the activity status of the leukemia, which could facilitate recurrence and regional or distant metastatic spread. Abreviations Small Lymphocytic Lymphoma (SLL). Merkel Cell Carcinoma (MCC) Chronic Lymphocytic Leucemia (CLL) Complete spontaneous regression constitutes 1.67% of the approximately 600 reported cases of MCC[26]. There- fore, MCC once recognized has to be treated agressively. Competing interests The author(s) declare that they have no competing interests. Page 5 of 6 (page number not for citation purposes)