Background Merkel cell carcinoma (MCC) is a very infrequent and aggressive skin tumor with high recurrence and metastasis rates. MCC treatment is currently not well defined.

Case presentation We present the case of a 75-year-old woman who was diagnosed with MCC in 2010 and suffered a third relapse in 2012 which could not be treated surgically.

Results The patient began oral etoposide treatment reaching complete response after eight cycles and receiving a total of 11 cycles. As side effects, the patient suffered from neutropenia, candidiasis and mucositis, but after reducing the dosage to 50% it was well tolerated.

Discussion Chemotherapy treatment in this setting is poorly defined. In this case, monotherapy treatment with oral etoposide was decided due to the patient’s age and comorbidities, achieving a very positive outcome.