Images of Malignancy: Case 3 Metastases to the Scalp

An 85-year-old man was admitted to the hospital with a cough and shortness of breath of 1 week’s duration and a fever and increased sputum production for 2 days. His history included renal cell carcinoma and metastatic renal cancer for 2 years. The patient had smoked cigarettes for 30 years. He had lost 30 lb during the last few months. A chest film revealed pneumonia of the right lower lobe. Metastatic nodules were noted on the scalp; extensive lung, bone, and brain metastases also were found. Cutaneous secondary lesions from renal cell carcinoma are uncommon; however, when they do occur, the scalp and face are most often involved. Generally, other sites of systemic metastasis exist; thus, these patients are not candidates for curative therapy. Mean survival after detection of cutaneous metastasis is less than 1 year. A thorough examination of the skin is warranted during tumor evaluation; aggressively assess all skin lesions in patients with renal cell carcinoma to rule out cutaneous metastasis. Cutaneous metastases usually develop from hematogenous or lymphatic system spread. In men, primary carcinomas of the lung, colon, and oral cavity, and melanoma most often metastasize to the skin. Breast, colon, and lung malignancies most frequently cause secondary skin tumors in women. Often, metastatic lesions may be the initial presentation of a carcinoma, particularly when the primary site is the lung, kidney, or ovary. This patient’s scalp lesions were treated with palliative radiotherapy. He died of respiratory failure a few days after admission.