Merkel cell carcinoma (MCC) is a neuroendocrine carcinoma of the skin that has a higher mortality (approximately 33% at three years) than melanoma in the general population. The fact that 8% of MCC cases have been encountered in solid organ transplant recipients (OTRs) indicates a greater than tenfold increased incidence among these patients. This increased risk among transplant patients and a 60% disease-specific mortality of MCC in this population make it an important issue in transplant medicine. Further challenges surrounding MCC include a therapeutic approach that is very different than that employed for other skin cancers, is controversial within the literature, and that is in a state of evolution. Optimal care of MCC in OTRs requires coordination between dermatologists, surgeons, transplant physicians, and radiation and medical oncologists.