Background: Merkel cell carcinoma is a rare skin malignancy of neuroendocrine origin that is highly aggressive and frequently metastasizes. Case Presentation: We present a case of Merkel cell carcinoma in which the patient developed metastatic gastric deposits that led to his admission to the acute medical unit with signs consistent with an upper gastrointestinal bleed. Treatment options in this case were limited to palliative radiotherapy (RT) given the patient’s multimorbid state. Unfortunately, our patient deteriorated during his admission and passed away. Conclusion: There have been few reports of Merkel cell carcinoma metastasizing to the stomach. In this case, we highlight an immediately life-threatening presentation with upper gastrointestinal bleeding that required prompt endoscopic intervention. The relatively recent initiation of immunotherapy as a management option for this underlying condition introduces a shift in treatment options that were previously limited to RT and chemotherapy.

Keywords: Case report, Merkel cell carcinoma, immunotherapy, metastasis, endoscopy