Images of Malignancy: Case 3 Metastases to the Scalp

An 85-year-old man was admitted to the hospital with acough and shortness of breath of 1 week's duration anda fever and increased sputum production for 2 days. Hishistory included renal cell carcinoma and metastatic renalcancer for 2 years. The patient had smoked cigarettesfor 30 years. He had lost 30 lb during the last few months.A chest film revealed pneumonia of the right lowerlobe. Metastatic nodules were noted on the scalp; extensivelung, bone, and brain metastases also were found.Cutaneous secondary lesions from renal cell carcinomaare uncommon; however, when they do occur, thescalp and face are most often involved. Generally, othersites of systemic metastasis exist; thus, these patientsare not candidates for curative therapy. Mean survivalafter detection of cutaneous metastasis is less than 1 year.A thorough examination of the skin is warranted duringtumor evaluation; aggressively assess all skin lesions in patients with renal cell carcinoma to rule out cutaneousmetastasis.Cutaneous metastases usually develop from hematogenousor lymphatic system spread. In men, primarycarcinomas of the lung, colon, and oral cavity, and melanomamost often metastasize to the skin. Breast, colon,and lung malignancies most frequently cause secondaryskin tumors in women. Often, metastatic lesions may bethe initial presentation of a carcinoma, particularly whenthe primary site is the lung, kidney, or ovary.This patient's scalp lesions were treated with palliativeradiotherapy. He died of respiratory failure a few daysafter admission.