Abstract:

Patients with renal cell carcinoma rarely experience metastatic disease, occurring in approximately 25% of patient cases (1). Only 1.0-3.0% of these patients experience cutaneous metastasis and often occurs as a late manifestation of the disease (2, 3). Metastatic RCC to the skin most commonly involves the scalp, followed by the chest and the abdomen. We present a unique case of a 64-year-old male patient with a history of RCC who presented to the ED with a blanching, purpuric nodule on the right lateral thigh. A 4mm punch biopsy was performed to rule out metastatic disease. The pathological examination revealed a dense dermal infiltrate of atypical cells, with variably prominent nucleoli and moderate vacuolated cytoplasm, with areas of cytoplasmic clearing. Immunohistochemisty was positive for cytokeratin AE1/AE3, Cam5.2, and PAX8. The histopathologic findings were consistent with metastatic renal cell carcinoma to the skin. To these authors knowledge, no previous reports in the literature describe a metastatic RCC to the cutaneous thigh. Unfortunately, evidence of skin metastasis has a poor prognosis and likely indicates late stage disease. However, with appropriate surgical excision, disease-free follow up is achievable. Our case contributes more information to the limited consolidation of rare oncologic cutaneous presentations, as the disease burden causes significant patient morbidity and mortality.

Financial Disclosure:
No current or relevant financial relationships exist.

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Niki Nourmohammadi, DO