Merkel cell carcinoma (MCC) is an infrequent tumor of cells of the basal layer of the epidermis or dermis and is related to sun exposure and the immune system. The risk of developing MCC is greater in renal transplant recipients than in the general population. In these patients, this tumor develops at younger ages and in multiple locations; in addition, this entity is more aggressive, more frequently recurs after treatment, and is associated with other tumors of the skin and with hematologic neoplasms. We describe the case of a 68-year-old male renal transplant recipient who developed multiple epidermoid carcinomas and MCC with regional metastasis after 4 years of receiving immunosuppressive therapy.