Cutaneous metastasis of renal carcinoma Gabriela Hertz Soares, MD,a Aimilios Lallas, MD, PhD,b Mara Lombardi, MD,b Caterina Longo, MD, PhD,b Elvira Moscarella, MD,b Margherita Raucci, LPN,b and Giuseppe Argenziano, MDb Porto Alegre, Brazil, and Reggio Emilia, Italy
CLINICAL PRESENTATION A 70-year-old man presented for evaluation of a solitary asymptomatic nodule on his right cheek. The tumor had appeared 2 months earlier and was rapidly growing (Fig 1). Clinical examination revealed a sharply demarcated, purple-red nodule of firm consistency, surrounded by an erythematous halo. Five months earlier the patient was diagnosed with renal cancer, for which he underwent chemotherapy.
Fig 1. Cutaneous metastasis or renal cancer. Two months after first being noticed, a rapidly enlarging purple-red nodule on the cheek of a 70-year-old man with diagnosed renal cancer.
DERMOSCOPIC APPEARANCE Dermoscopically, the tumor displayed a purple color and linear vessels of large diameter. The vessels in the center were distributed in a parallel fashion and intermingled with white lines, while at the periphery they were branching and combined with white structureless areas (Fig 2). Although suggestive of a vascular tumor, the overall dermoscopic pattern was unspecific and not compatible with the diagnosis of angioma. Accordingly, the tumor was surgically excised and histopathologically examined to rule out malignancy.
From the Ambulat orio de Dermatologia Sanitaria,a Porto Alegre, Brazil, and the Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS,b Reggio Emilia, Italy. Publication of this article was supported by 3Gen. Funding sources: Study supported in part by the Italian Ministry of Health (RF-2010-2316524). Conflicts of interest: None declared.
Reprint requests: Aimilios Lallas, MD, Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova, Viale Risorgimento 80, 42100 Reggio Emilia, Italy. E-mail: [email protected]. J Am Acad Dermatol 2015;72:S45-6. 0190-9622/$36.00 ª 2014 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2014.06.008
S45
S46 Soares et al
J AM ACAD DERMATOL
JANUARY 2015
Fig 2. Cutaneous metastasis or renal cancer. Dermoscopy revealed a purplish-red color and numerous linear vessels of large diameter. The vessels in the center were distributed in a parallel fashion and combined with white lines, while at the periphery they showed some ramifications.
HISTOLOGIC DIAGNOSIS Histopathologic examination revealed a dermal hemorrhagic nodule consisting of large neoplastic cells with abundant clear cytoplasm, which were immunoreactive with CD10 (Fig 3). Combining the latter findings with the patient’s history, the diagnosis of cutaneous metastasis of renal clear cell carcinoma was established.
Fig 3. Cutaneous metastasis or renal cancer. Histopathologic examination revealed a dermal hemorrhagic nodule consisting of large neoplastic cells with abundant clear cytoplasm (lower inset), immunoreactive with CD10 (upper inset). The latter findings were consistent with the diagnosis of cutaneous metastasis of renal clear cell carcinoma.
KEY MESSAGE Unless displaying a dermoscopic pattern of red lacunas that typifies angioma, a vascular tumor of recent onset should be excised to rule out malignancy. The latter is particularly relevant in patients with diagnosed internal malignancy, in which the vascular lesion might represent a cutaneous metastasis of the visceral neoplasm.
CLINICAL PRESENTATION A 70-year-old man presented for evaluation of a solitary asymptomatic nodule on his right cheek. The tumor had appeared 2 months earlier and was rapidly growing (Fig 1). Clinical examination revealed a sharply demarcated, purple-red nodule of firm consistency, surrounded by an erythematous halo. Five months earlier the patient was diagnosed with renal cancer, for which he underwent chemotherapy.
Fig 1. Cutaneous metastasis or renal cancer. Two months after first being noticed, a rapidly enlarging purple-red nodule on the cheek of a 70-year-old man with diagnosed renal cancer.
DERMOSCOPIC APPEARANCE Dermoscopically, the tumor displayed a purple color and linear vessels of large diameter. The vessels in the center were distributed in a parallel fashion and intermingled with white lines, while at the periphery they were branching and combined with white structureless areas (Fig 2). Although suggestive of a vascular tumor, the overall dermoscopic pattern was unspecific and not compatible with the diagnosis of angioma. Accordingly, the tumor was surgically excised and histopathologically examined to rule out malignancy.
From the Ambulat orio de Dermatologia Sanitaria,a Porto Alegre, Brazil, and the Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS,b Reggio Emilia, Italy. Publication of this article was supported by 3Gen. Funding sources: Study supported in part by the Italian Ministry of Health (RF-2010-2316524). Conflicts of interest: None declared.
Reprint requests: Aimilios Lallas, MD, Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova, Viale Risorgimento 80, 42100 Reggio Emilia, Italy. E-mail: [email protected]. J Am Acad Dermatol 2015;72:S45-6. 0190-9622/$36.00 ª 2014 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2014.06.008
S45
S46 Soares et al
J AM ACAD DERMATOL
JANUARY 2015
Fig 2. Cutaneous metastasis or renal cancer. Dermoscopy revealed a purplish-red color and numerous linear vessels of large diameter. The vessels in the center were distributed in a parallel fashion and combined with white lines, while at the periphery they showed some ramifications.
HISTOLOGIC DIAGNOSIS Histopathologic examination revealed a dermal hemorrhagic nodule consisting of large neoplastic cells with abundant clear cytoplasm, which were immunoreactive with CD10 (Fig 3). Combining the latter findings with the patient’s history, the diagnosis of cutaneous metastasis of renal clear cell carcinoma was established.
Fig 3. Cutaneous metastasis or renal cancer. Histopathologic examination revealed a dermal hemorrhagic nodule consisting of large neoplastic cells with abundant clear cytoplasm (lower inset), immunoreactive with CD10 (upper inset). The latter findings were consistent with the diagnosis of cutaneous metastasis of renal clear cell carcinoma.
KEY MESSAGE Unless displaying a dermoscopic pattern of red lacunas that typifies angioma, a vascular tumor of recent onset should be excised to rule out malignancy. The latter is particularly relevant in patients with diagnosed internal malignancy, in which the vascular lesion might represent a cutaneous metastasis of the visceral neoplasm.
