Abstract： To the editor:Merkel cell carcinoma (MCC) is an extremely rare primary neuroendocrine neoplasm of the skin.It occurs more frequently in elderly and immunosuppresed individuals with a male predominance.1 Merkel cell polyomavirus (MCPyV) has been recently associated with MCC,which was described as one of 7 known human oncogenic viruses.2 MCC is characterized by early and rapid metastases,although there are some reported cases with spontaneous regression.3 Mohs micrographic surgery should be considered for treatment of MCC.However,successful treatment still lies in diagnosis and therapy at the early stage of disease,consisting of regular dermatological checkups in older immunocompromised individuals,and early initiation of combination therapy including radical surgical treatment,radiotherapy,and chemotherapy.