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Although considered a rare form of nonmelanoma skin cancer, Merkel Cell Carcinoma incidence rate has increased to 0.74 per 100,000 and projections expect this number to steadily rise over the next decades and to reach an average of 3,285 cases per year in 2025. MCC incidence increases significantly with age. Among those aged 40-44, it is 0.44, it rises to 1.0/100,000 in the 60-64 age group and soars to 9.8/100,000 among those≥ 85 years and above. Due to the small number of cases, MCC is often managed using institutional practices or provider preferences. Formal clinical trials that enroll early stage MCC are ongoing and therefore, robust estimates of overall survival by stage and clinical management are not yet available. However, case series and retrospective studies and single-site studies suggest better overall survival with early stages. Thus, the real benefit of current standard of care needs to be assessed in early-stages to obtain a comprehensive overview of MCC treatment. Further, chronic conditions are highly prevalent in older adults with MCC. Although, evidence speaks of their prevalence, less is known about their temporal origin and their influence on cancer treatment choice. As older adults with cancer have on average three or more chronic conditions, these comorbidities typically precede a cancer diagnosis. Patients with comorbidities have poor prognosis and survival, are less likely to receive curative treatment choices and also are more likely to be offered less aggressive care. Thus, the presence and type of chronic conditions in MCC requires serious investigation as well as their impact on the choice of MCC treatment …