Metastatic Renal Cell Carcinoma

The sudden appearance of an asymptomatic, 6 x 4.5-mm, exophytic, red nodule on the chin prompted an ostensibly healthy 73-year-old nonsmoker to seek medical attention. His nodes were not enlarged, and he had no other skin lesions.

Ted Rosen, MD, of Houston reports that the results of a biochemical panel, urinalysis, complete blood cell count, and chest radiograph were all normal. Histopathologic examination of a biopsy specimen of the lesion revealed a dense, dermal infiltrate of cytologically atypical polyhedral cells embedded within a highly vascular stroma; these findings suggested renal cell carcinoma. An abdominal CT scan revealed a mass within the right kidney. Ten days after the initial presentation, a red-purple nodule developed in the left axilla; histologic findings were identical to those of the facial lesion.

Renal cell carcinoma with widespread peritoneal involvement was found on abdominal exploration. Between 2% and 5% of all internal malignancies develop cutaneous metastases. Such lesions may be the initial manifestation of cancer, especially when the primary neoplasm is located in the kidney or lung. Cutaneous metastases are generally associated with a poor prognosis. This patient refused additional evaluation or therapy, and he died within 6 months.