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Title

A case report of Merkel cell carcinoma of the eyelid after previously diagnosed and treated conjunctival intraepithelial neoplasia.

Purpose	We present the case of a Merkel cell carcinoma (MCC) of the eyelid in a patient that previously was diagnosed and treated for a conjunctival intraepithelial neoplasia (CIN) in the same area.
Methods	A case report
Results	A 76-year old woman was diagnosed with CIN and was referred to our clinic for suspicion of recurrence in 2010. Biopsy confirmed a CIN type III and topical treatment with 5-fluorouracil enabled complete remission. She developed secondary conjunctival scarring of her right upper eyelid with entropion and trichiasis, that caused corneal ulcera and irreversible corneal scarring. In 2012 a new recurrence of CIN of the right lower eyelid was treated with topical inferferon-α2b. Treatment was interrupted after 6 months because of central corneal ulceration but a biopsy in 2013 revealed no recurrence of CIN, only inflammation. In May 2019 she presented to the emergency department complaining of progressive swelling and itching of the right lower eyelid. Biomicroscopy revealed a red bulging mass and subsequent biopsy was compatible with a Merkel cell carcinoma. The patient underwent an exenteration of the right orbit. Additional investigations including MRI of the orbit, PET-CT of the body and sentinel lymph node biopsy revealed no metastasis.
Conclusion	Merkel cell carcinoma is a rare, highly aggressive neuro-endocrine skin tumor which affects the eyelids in 5-10% of the cases. 40% of MCCs are associated with adjacent or overlying Bowen’s disease or squamous cell carcinoma (SCC) of the skin. This is the first case presenting MCC associated with ocular surface squamous neoplasia.
Conflict of interest	No

Authors 1

Last name	VAN OEVELEN
Initials	K
Department	University hospital of Antwerp, department of Ophthalmology
City	Antwerp

Authors 2

Last name	De Groot
Initials	V
Department	University hospital of Antwerp, department of Ophthalmology
City	Antwerp

Authors 3

Last name	De Keizer
Initials	RJW
Department	University hospital of Antwerp, department of Ophthalmology
City	Antwerp

Authors 4

Last name	Lauwers
Initials	N
Department	University hospital of Antwerp, department of Ophthalmology
City	Antwerp