Background:Merkel cell carcinoma (MCC) is a rare and typically aggressive form of skin cancer. The benign appearance of the tumor usually on exposed skin parts, contrasting with its extensive microscopic invasion, can delay timely diagnosis.Mainobservations:We report a case of a 71-year-old man with a slowly progressive nodule on the left hand.Conclusion:At the dermoscopic examination, the presence of a polymorphous vascular pattern, including milky-red areas may constitute an additional clinical clue to accurately diagnose this rare tumor. Clinical, dermoscopic and histological features are discussed.