Metastatic Renal Cell Carcinoma to the Scalp: A Case Report With Review of Literature

Abstract

Renal cell carcinoma (RCC) is the most common type of renal neoplasm. It accounts for 3% of solid tumors in adults and mostly affects men with the peak incidence between the fifth and seventh decades. It metastasizes mainly through the hematogenous spread, and the lung is the most common site of metastasis followed by bone, lymph node, liver, brain, and adrenal glands. Skin metastasis is extremely rare and accounts for <7% of RCC metastases, with the scalp and face being the most reported sites. Skin metastases are usually diagnosed at a later stage of the disease, commonly post-nephrectomy, and are regarded as a poor prognostic factor. Here we report a case of a 54-year-old male who presented with a red, pedunculated, bleeding, and nontender scalp lesion (2x2cm in size) found on the right parietal area. with a history of left radical nephrectomy and adjuvant chemotherapy for clear cell RCC 17 years ago, as well as laminectomy and radiotherapy for bone metastases in C5 and C6 in 2015. After surgical excision of the scalp lesion, histology revealed metastatic clear cell RCC. The patient was doing well post-surgical excision and was referred back to oncology where palliative care and supportive treatment were initiated. In the span of five months postresection, he developed several conditions where his health further deteriorated. He was announced dead in September 2022 due to cardiac arrest. This case highlights the occurrence of scalp metastases long after the surgical resection of RCC.

Metastatic Kidney Cancer: Does the Location of the Metastases Matter? Moving towards Personalized Therapy for Metastatic Renal Cell Carcinoma

“…It is surprising that there is limited information available on the effectiveness and safety of immunotherapy in patients with metastatic RCC who have bone metastases. While a few case reports have shown positive results in terms of radiological response in metastatic RCC patients treated with ICIs, there is still a need for more prospective data [76][77][78][79][80]. Nevertheless, reliable evidence on the efficacy of ICIs in bone metastases primarily comes from a subgroup analysis of the CheckMate 025 trial.…”

Dermoscopy of cutaneous metastasis of renal cell carcinoma

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Key message Cutaneous metastases of RCC present as red-to-purple papulonodules favoring the head and neck. 1 They may clinically mimic vascular neoplasms, melanoma, or basal cell carcinoma (BCC). The lesion presented here was unusual for RCC due to its initial fleshy color but subsequently regrew with a characteristic violaceous color of RCC metastases, likely due to extensive tumor vascularity.

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A case report of renal cell carcinoma metastasis revealed through late‐onset thyroid nodules

“…The precise mechanism of RCC metastasis is still unknown; however, hematogenous metastasis, lymphogenous dissemination, and direct invasion are some possible ways. 6,7 Metastasectomy is typically reserved for cases where complete resection is feasible unless the primary goal of treatment is palliative symptom management. When considering surgery, it is crucial to weigh the potential morbidity and mortality associated with metastasectomy.…”

“…The most common sites for metastatic RCC are the lungs, lymph nodes, bone, and liver. The precise mechanism of RCC metastasis is still unknown; however, hematogenous metastasis, lymphogenous dissemination, and direct invasion are some possible ways 6,7 …”

“…The precise mechanism of RCC metastasis is still unknown; however, hematogenous metastasis, lymphogenous dissemination, and direct invasion are some possible ways. 6 , 7 …”