Abstract
Merckel cell cancer is a rare Neuroendocrine malignant neoplasm of the skin. Major risk factors are advanced age, UV radiation and Immunocompromised state. Treatment of primary Merkel cell cancer involves surgical resection and adjuvant radiotherapy. Chemotherapy and Immunotherapy are usually reserved for treating advanced metastatic cases. We present a case of sixty-seven-year-old man who is diagnosed with metastatic Merckel cell cancer of skin and lymph nodes. After consultation with multidisciplinary team, the patient started immunotherapy with Avelumab. He later received concurrent Radiation therapy with short lasting response. Unfortunately, his disease progressed, and the patient received one cycle of chemotherapy prior to transitioning to comfort care.