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Context :Merkel cell carcinoma is an aggressive cutaneous tumor without clearly defined treatment and high propensity for metastasis. Case report :This case describes a sixty four year old presenting with obstructive jaundice approximately two years after having a Merkel cell carcinoma resected from his finger. He underwent a successful pancreaticoduodenectomy with pathology confirming metastatic Merkel cell carcinoma. This report reviews the history, presentation, and current treatment recommendations for Merkel cell carcinoma. We propose that resection of metastases from Merkel cell carcinoma may confer a survival advantage and should be strongly considered, particularly if isolated.