Cutaneous Metastases in Renal Cell Carcinoma

Abstract

Cutaneous metastasis from renal cell carcinoma is believed to be rare. We present our experience with 10 (3.3%) cases seen in the last 12 years among 306 cases of renal adenocarcinoma treated at our center. There were 9 males and 1 female. Age ranged from 30 to 65 years (average 45 years). 5 patients had skin metastases at the time of presentation (stage IV). In one of them the skin nodule, rather than urologic symptoms, was the presenting complaint. 5 patients presented with skin metastasis during follow-up after nephrectomy. The average time to skin metastasis was 51 months for patients in stage I and 13 months in stage IIIb. The scalp was the most common site of metastasis followed by chest and abdomen. 90% of patients had secondaries in at least one other site, most commonly in lungs (4 cases) and bones (5 cases). 4 patients were treated with interferon-α 6 MIU, subcutaneously, three times a week for varying periods from 3 to 4 months but there was no response. In conclusion, cutaneous secondaries from RCC, though uncommon, are not very rare. A few patients may present with a skin mass before detection of the renal tumor. Patients with low-stage disease at presentation may also develop cutaneous secondaries, therefore a prolonged follow-up is required. The commonest site for cutaneous metastasis from RCC is the scalp and face. Most patients had at least one other site of systemic metastasis, hence they were not candidates for curative therapy. Interferon therapy was not helpful. Mean survival after detection of cutaneous metastasis was 7 months.

Tumor type-specific and skin region-selective metastasis of human cancers: another example of the “seed and soil” hypothesis

“…To further support the observations above, we compiled 444 skin metastasis cases from 7 previous reports with different primary tumors and corresponding regional distribution data [10,11,15,18,[22][23][24] and from 2 lung cancer-specific studies [25,26]. These data strongly support the notion that lung cancer preferentially produces chest (and less frequently head and neck) skin metastases, while colorectal cancer prefers abdominal skin locations in more than two thirds of the cases (Fig.…”

“…We performed a meta-analysis on 174 skin metastatic cases reported in five different studies [15,18,[22][23][24] to identify location preferences of the primary tumors from different organs (Table 3). Importantly, lung, colorectal, and urogenital cancers displayed a preference to metastasize to their Data are expressed in percent of the number of respective cancer cases corresponding supradiaphragmatic and infradiaphragmatic skin regions.…”

Skin Metastasis of Internal Cancers: A Single Institution Experience

“…Correct survival data were unavailable for most of our patients, prognosis after skin metastasis is very poor with only 7.5 months life expectancy, according to the literature [10]. Long term survival after surgical excision of skin metastasis was described only in a case of solitary skin metastasis of renal cell carcinoma [14].…”

Recurrent eccrine hidradenoma of the breast in a male patient: problems in differential diagnosis

“…The breast location of this tumor and its particular histological findings include in the differential diagnosis a primary breast ductal carcinoma [3], a metastatic clear cell carcinoma [4], an adenomyoepithelioma [5] and primary skin tumors with follicular differentiation, sebaceous differentiation, or sweat gland differentiation [6]. Against a diagnosis of a primary breast ductal carcinoma, there weren't ductular structures around the tumor, cytological atypia was lacking and the neoplastic proliferation had a biphasic cellular population [3]; moreover, mammaglobin, GCDFP15, ER and PR immunohistochemical staining were negative, whereas in a well differentiated breast ductal carcinoma they would expect to be positive.…”

“…Common locations are head, neck and limbs [2]. The histologic appearance put in the differential diagnosis other skin neoplasms and other tumors depending on the location [3][4][5][6]. These tumors are usually benign but they can have rarely low malignant potential, and they should be surgically removed with safety margins, because they have a high local recurrence rate and a potential of malignant transformation [7].…”