A Pedunculated Skin Lesion in a Case of Clear Cell Renal Carcinoma

Abstract

Clear cell type renal carcinoma accounts for about 80% of all renal cell carcinomas. We present a 39-year-old male with clear cell renal carcinoma of the right kidney, stage I: T1 b (5 cm) N0 M0, who developed cutaneous metastases in the right submandibular region 28 months after nephrectomy. Our case is unique as i) the patient with stage I cancer (at the time of nephrectomy) presented with an isolated cutaneous nodule in a location distant from the primary site; ii) cutaneous nodule developed while being treated with pazopanib for metastatic lesions in the lung and adrenal; and iii) nivolumab and ipilimumab combination therapy decreased the vascularity of the nodule though it did not halt the nodule growth. Physicians should be knowledgeable about this rare clinical entity and its varied presentation. Further studies are necessary to determine optimal treatment, as the current therapeutic agents for metastatic renal carcinoma might not be adequate for cutaneous metastasis.

An Atypical Cutaneous Metastasis in a Case of Clear Cell Renal Carcinoma

“…Cutaneous metastases are not a common finding in the setting of ccRCC [1][2][3][4][5][6][7]. They are usually seen in the final stages of the disease but can be found at any stage and at any time [7]. Our patient's time of presentation is consistent with the timing described in the literature, as he had a stage IV ccRCC.…”

“…Our patient's time of presentation is consistent with the timing described in the literature, as he had a stage IV ccRCC. Some typical sites of cutaneous metastases are the chest and the abdomen due to anatomic proximity to the kidneys, and the scalp due to lymphohematogenous dissemination, as noted above [7]. Our case shows these features; however, its presentation is unique in the sense that the characteristics of the lesion are atypical.…”

“…Cutaneous metastases are not a common finding in the setting of ccRCC [1][2][3][4][5][6][7]. They are usually seen in the final stages of the disease but can be found at any stage and at any time [7].…”

“…We found other case reports of cutaneous involvement of renal cell carcinoma (RCC). In most of these reports, the presenting lesion consisted of a nodule or a pedunculated lesion, which is the classical presentation of skin metastases of RCC [1,3,[6][7][8][9][10].…”

Sarcomatoid renal cancer with multiple cutaneous metastases

“…(20) La decisión terapéutica es individualizada y requiere de manejo multidisciplinario dependiendo el estadio, la extensión y el estado funcional del paciente en cuestión, como podemos observar en la Tabla 1 donde se presenta el manejo de las metástasis cutáneas por cáncer renal en casos reportados de 2015 a 2020 y su evolución posterior. (3,(16)(17)19,(21)(22)(23)(24)(25)(26)(27)(28) Debido a que se trata de una entidad rara, nos encontramos ante pocos datos sobre el manejo óptimo de estos pacientes, encontrándose que en la actualidad no existe un tratamiento estándar o de primera línea para pacientes con sRCC. (29) La diferenciación sarcomatoide presenta pobre respuesta a tratamientos actualmente empleados, como el sunitinib, al compararlo con carcinomas renales sin este tipo de diferenciación incluso en estadios avanzados.…”