Mohs surgery in metastatic cancer: renal cell carcinoma solitary cutaneous metastasis and visceral tumor metastases to skin treated with microscopically controlled surgical excision

Anzalone, C. Lane; Cohen, Philip R.; Migden, Michael R.; Tannir, Nizar M.

doi:10.1111/ijd.12021

Cited by 6 publications

(5 citation statements)

References 27 publications

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“…Thirteen cases were post-nephrectomy for RCC before the presentation of their scalp lesions [1,[4][5][6][7][8][9][10][11][12][13][14]. However, three patients have confirmed the diagnosis of RCC without nephrectomy [15][16][17]. The mean time interval between the treatment of the primary RCC and the diagnosis of the scalp lesion was 33 (range: 0-180) months.…”

Section: Discussionmentioning

confidence: 99%

“…Partial or radical nephrectomy is the mainstay management of RCC, and it is considered a cytoreductive strategy in patients with metastatic RCC [25]. For most cases in the literature, surgical excision was done for the scalp mass [1][2][3][4]6,[8][9][10][11][12][13]15,16,18,20]. Our patient was similarly managed by excising the scalp lesion.…”

Section: Authormentioning

confidence: 99%

“…The median survival of metastatic clear cell RCC is about 13 months with five-year survival under 10% [29,30]. When the literature was reviewed, 10 patients died within a mean of 8.4 months after the detection of skin metastasis [9,11,12,15,16,21].…”

Section: Authormentioning

confidence: 99%

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

Meshikhes¹,

Khatem²,

Albusaleh³

et al. 2023

Cureus

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Authormentioning

confidence: 99%

See 1 more Smart Citation

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

Meshikhes¹,

Khatem²,

Albusaleh³

et al. 2023

Cureus

View full text Add to dashboard Cite

show abstract

“…According to previous studies and reviews of RCC, metastatic RCC to the skin is rare. Less than 100 reports of RCC with metastasis to the skin and less than 20 with metastasis to scalp have been reported (Table 1) [1, [5][6][7][8][9][10][11][12]. RCC spreads via various mechanisms including hematogenous dissemination, lymphatic extension, direct invasion from underlying tumor, and implantation from procedures.…”

Section: Discussionmentioning

confidence: 99%

Cutaneous metastatic renal cell carcinoma to the scalp

Yang

Kang

2019

Arch Craniofac Surg

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Renal cell carcinoma (RCC) represents 2% to 3% of human cancers and is aggressive, with metastatic capability. The frequent metastatic sites are lung, bone, and liver. Reports of RCC metastatic to skin, and especially scalp are rare. Here we present an 83-year-old woman who was diagnosed with RCC 19 years prior and had a metastatic scalp lesion. An 83-year-old woman presented with a red-to-purple, protruding lesion at the right parietotemporal area. Twenty-three years ago, a right renal mass was incidentally discovered on ultrasound through a routine medical examination. She underwent right nephrectomy for RCC 4 years later. Five months after nephrectomy, new lung nodules were observed. Fifteen years after nephrectomy, metastatic lesions were found in the pelvic bone. She visited dermatology department for evaluation of the new scalp lesion, a year before she first visited our department. Despite chemotherapy, the mass was gradually enlarged. She consulted the plastic surgery department for management of the metastatic RCC was successfully treated with total excision including a 1-cm safety margin, local flap, and STSG coverage. Complete healing was observed, without evidence of recurrence during a 7-month followup. Metastases to the skin are rare, but must be kept in mind because of its high metastatic ability and poor prognosis.

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“…Under the appropriate circumstances, successful use of MMS has also been reported in a variety of situations as cutaneous metastases, erosive adenomatosis of the nipple, recurrent eccrine spiradenoma, and neoplasms in the fibromyxoma spectrum…”

Section: Discussionmentioning

confidence: 99%

State of the art of Mohs surgery for rare cutaneous tumors in the Spanish Registry of Mohs Surgery (REGESMOHS)

et al. 2019

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Background The use of Mohs micrographic surgery (MMS) for rare cutaneous tumors is poorly defined. We aim to describe the demographics, tumor presentation and topography, surgery characteristics and complications of MMS for rare cutaneous tumors in a national registry.Methods Prospective cohort study of patients treated with MMS in Spain between July 2013 and June 2018. The inclusion criteria were patients with cutaneous tumors with final diagnosis different from basal cell carcinoma, squamous cell carcinoma, dermatofibrosarcoma protuberans, or any kind of melanoma.Results Five thousand and ninety patients were recorded in the registry, from which only 73 tumors (1.4%) fulfilled the inclusion criteria: atypical fibroxanthoma (18), microcystic adnexal carcinoma (10), extramammary Paget's disease (7), Merkel cell carcinoma (5), dermatofibroma (4), trichilemmal carcinoma (4), desmoplastic trichoepithelioma (4), sebaceous carcinoma (3), leiomyosarcoma (2), porocarcinoma (2), angiosarcoma (2), trichoblastoma (1), superficial acral fibromyxoma (1), and others (10). No intra-surgery morbidity was registered. Postsurgery complications appeared in six patients (9%) and were considered mild. Median follow-up time was 0.9 years during which three Merkel cell carcinomas, one angiosarcoma, one microcystic adnexal carcinoma, and four others recurred (12.3%).Conclusion This national registry shows that rare cutaneous tumors represent a negligible part of the total MMS performed in our country with a low complication rate.

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Mohs surgery in metastatic cancer: renal cell carcinoma solitary cutaneous metastasis and visceral tumor metastases to skin treated with microscopically controlled surgical excision

Abstract: We suggest that, in the appropriate setting, surgical excision of isolated cutaneous metastases using microscopically controlled margins at the time of surgery should be added to the indications for Mohs surgery.

Cited by 6 publications

References 27 publications

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

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

Cutaneous metastatic renal cell carcinoma to the scalp

State of the art of Mohs surgery for rare cutaneous tumors in the Spanish Registry of Mohs Surgery (REGESMOHS)

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