Merkel cell carcinoma (MCC) is an aggressive neuroendocrine skin malignancy that clinically present as a rapidly growing, non-tender, firm, red or violaceous nodule on sun-exposed skin. [1]. MCC occurs primarily in elderly and immunosuppressed patients, and mostly affects white patients with a male predominance. [1, 2] Most common areas at presentation are the head and neck region followed by the extremities. [3] The incidence and mortality of MCC has significantly increased over the past three decades with 33% mortality within 3 years of diagnosis. [3]. MCC tends to display an early and aggressive local and systemic dissemination. At diagnosis, approximately 65–70% of the patients have clinically localized disease to the skin, approximately 25% have palpable regional lymphadenopathy, and 5–8% already has metastatic disease. MCC can metastasize to any site and most frequent areas of metastasis are the lymph nodes, liver, lungs, subcutaneous tissue and bone. [4] Metastasis to the pancreas is rare but has been previously reported. [5,6]