BMC Cancer 2005, 5:106 http://www.biomedcentral.com/1471-2407/5/106 (FHhiiagsetuomrpeaatto2hxoylolingyanshdoewoisning;u×nd1i0ff0e)rentiated small cell carcinoma with paucicellular stroma and cells forming nodules or rosettes Histopathology showing undifferentiated small cell carcinoma with paucicellular stroma and cells forming nodules or rosettes (haematoxylin and eosin; × 100). confirmed MCC (small atypical cells were found, isolated or forming rosettes and exhibited dense core granules of chromatin and scanty cytoplasm). The patient underwent one month of neck radiotherapy with Cobalt 60, a total dose of 4600cGy in 23 days. A further boost of 600cGy in 2 days, on the left submandibular area was administered. The treatment was successfully completed with full remis- sion of the cervical lymphadenopathy. Two months fol- lowing the radiotherapy, a new CT scan of the head and neck showed reduction and obscurrence of the pre-exist- ing mass on the left mandibular area, while the lymph nodes were smaller too. The patient is on regular follow up and CLL status is stable with no evidence of progres- sion or further recurrence of MCC 9 months post- radiotherapy. Conclusion Our patient represents another case of MCC arising on CLL and this ocurrence re-inforces the postulated correla- tion between these 2 malignancies. There are two main aetiological factors associated with increased risk of skin cancers: Ultraviolet radiation and immunosupression. CLL is thought to cause immunosupression and alcylating agents and other immunosuppressant therapies may be involved [22]. A higher incidence of MCC is seen in patients with organ transplantation, with human immun- odeficiency virus-1 infection or with advanced cancer and anergic status [23]. On the other side, CLL is relatively common and the asso- ciation with skin cancers, including the rarer MCC, may be coincidental [24]. The submandibular Page 4 of 6 (page number not for citation purposes)