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Figure 2: Right-sided Merkel cell carcinoma of the temporal region in a 63-year-old male. The lesion started as a small violaceous nodule approximately six months prior to presentation. This was excised locally at an outside institution and subsequently recurred in the region of the previous excision. The lesion subsequently enlarged and resulted in right-sided weakness in the distribution of the frontal branch of the facial nerve. Pain in the region was mild. Subsequent biopsy revealed MCC. Note multinodular cutaneous induration and anterior violaceous appearance, classic for advanced MCC.