Merkel cell carcinoma is a rare but aggressive neuroendocrine tumor of the skin with high propensity for local, regional and distant soft tissue metastasis not only at initial presentation but also after timely and satisfactory wide-margin surgery. Bone metastases account for 10% of all cases and have been reported involving the calvarium, facial bones and spine related to the head and neck preferential location of this soft tissue malignancy. Appendicular skeletal dissemination is uncommon with only a few cases reported in the radiological literature. We present a case of isolated tibial metastasis from Merkel cell carcinoma occurring 19 months after a technically adequate head and neck tumor resection and lymphadenectomy.