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BACKGROUND: Merkel cell carcinoma (MCC) is a rare, very aggressive tumour. The pathogenesis remains unclear, but UV radiation, immunosuppression, and the presence of Merkel cell polyomavirus in the tumour genome appear to have a key role. Merkel cell carcinoma is a highly aggressive tumour that often has a lethal end. CAS REPORT: A patient at 93 years of age comes for an examination by a dermatologist due to a rapidly growing nodular tumour growth in the forehead area. A tumour was about 3 cm in size. It had no signs of basal- cell carcinoma, no arborising vascularisation, no pigmentations on dermoscopy. Clinically, an eventual Merkel cell carcinoma was considered for the patient, but other primary skin tumours had to be excluded, as well as the possibility that regarding the patient’s age, it may be a metastatic deposit. A skin biopsy was performed, as well as H-E examination and immunohistochemical analyses (positive CD56, positivity of neuroendocrine markers synaptophysin, chromogranin) which were in favour of Merkel cell carcinoma of the skin. After setting the diagnosis, our patient was treated with therapy which led to a complete withdrawal of a tumour. However, after 3 months the patient had repeated relapse of a tumour at the same site on the forehead and metastases in the retroauricular lymph nodes bilaterally. It shows that the radiotherapy as monotherapy has a great effect on the removal of the tumour formation, but unfortunately, it has no impact on lesion recurrence. It is also compatible with the literature data. CONCLUSION: In many adult patients, as our case suggests, radiotherapy could be a good palliative treatment opportunity that should be considered, as well as a combination of radiation therapy with other oncologic therapeutic options.

Osteosarcoma is a very rare malignant bone tumor with an incidence of 4-6 cases in 1,000,000 inhabitants and appears mostly in the young and active population aged 1030 years (Price & Jeffree, 1977). Amputations and disarticulations as dominant treatment for malignant bone tumors in the beginning of 20th century are rarely and very selectively used today. Before 1970, amputation was the primary treatment for high-grade osteosarcoma and 80% of patients died of lung metastatic disease. Despite aggressive and radical surgery, 5year survival was low (10-20%) (Rosen et al., 1976). Introducing new sophisticated diagnostic methods (CT and MRI) gave the possibility of precise anatomic definition of the tumors and the borders of infiltration into the surrounding tissues. Better planning of the biopsy and the definite operative procedure, and fostering better patient selection for specific treatment strategies, can decrease the risk of tumor spread into the surrounding tissue and lower the risk of distant metastases. After 1980, improvement of chemotherapeutic protocols with neoadjuvant chemotherapy, better preoperative planning and modern reconstructive options after resection of osteosarcoma led to better survival rates of patients with limb-sparing procedures (Bacci et al., 1993, Bruland & Phil, 1999). Currently, 80 85% of the patients with osteosarcoma on the extremities can be safely treated with wide resection and limb preservation (Di Caprio et al., 2003). A multidisciplinary approach to diagnosis and treatment, combination chemotherapy and a number of options for reconstruction after osteosarcoma resection (especially in chemotherapy-sensitive tumors) have increased long-term survival rates from 60 to 80%. Amputations, once a dominant treatment for malignant bone tumors, now are rarely and very selectively used. Most patients with extremity-localized osteosarcoma are candidates for limb-sparing procedures because of the: effective chemotherapeutic agents and regimens, the improved imaging modalities, and advances in reconstructive surgery.