Renal cell carcinoma presenting with cutaneous metastasis: case report

Skin metastasis of RCC may be solitary or multiple manner. Its view may be normal skin color, as well as, brown, black or purple due to the accumulation of hemosiderin.[] The view of skin metastasis of RCC is often papules, plaques or nodules.[] The lesions may be in milimetric size and also up to a few centimeters in size. Because of its appearance, skin metastasis of RCC may be confused with hemangioma, pyogenic granuloma, Kaposi’s sarcoma, skin cysts and skin lymphoma. [] In our case, metastatic skin lesions were about 1 cm in size, red-purple in color and nodular style. The skin metastasis of RCC was diagnosed with skin biopsy.

Tumor cells are typically large, have clear cytoplasm, round or oval-core and a significant nucleolus.[] Immunohistochemically, epithelial cell markers such as the keratin, EMA, CEA and vimentin shows positive staining.[] In our case, in the biopsy of nodules, under microscopic squamous epithelial the atypical cells with clear cytoplasm were observed. Since it was determined that immunoperoxidase showed positive staining with EMA and vimentin, it was reported as metastatic RCC.

Skin metastasis of RCC is usually emerge late stage, it may emerge years after nephrectomy and sometimes before the diagnosis of renal tumors.[] Skin metastasis of RCC is a late stage sign, 90% together with synchronized visceral metastasis and a symptom of poor prognosis.[] 5-year survival rate with metastatic RCC is under 10%.[] There are publications specifying that the average life expectancy in cases of skin metastasis developed is less than 6 months,[] less than 8 months[] and around 12.7 months.[] In our case, skin metastasis developed 5 years after nephrectomy. Until the development of skin metastasis, it is remarkable that the table becomes worsening with the development of skin metastasis in the patient with lung, brain and bone metastases and dies after 1 month.

Since skin metastasis of RCC is together with disseminated disease in most cases, the therapy is limited and palliative. If there is focal skin metastasis, surgical treatment, radiotherapy, or both can be combined.[] Gay and colleagues reported that complete tumor regression was achieved over patient with a solitary skin metastasis of RCC with sorafenib treatment after radiotherapy. [] Systemic treatment is recommended to RCC patients with diffuse skin metastasis.[] As in our case, we have the vision that local treatments are limited in cases with diffuse skin metastasis. We stand for that he should be treated with systemic chemotherapy in appropriate cases. Due to his poor performance status, our patient was treated symptomatically.

As a result, the skin metastasis of RCC is extremely rare. It is more common in males, and head and neck region. As an indicator of poor prognosis, it should not be forgotten that purplish red skin lesions especially on head and face might be metastasis.