Metastasis to the scalp as the first finding of Clear Cell Carcinoma of the Kidney: Case Report and Review of the Literature

The case of a 70-year-old man, with no previous pathological history, who consulted for post-traumatic injury to the scalp; it was managed as a benign lesion and it was taken to surgical resection with a histopathology and immunohistochemistry study compatible with clear cell neoplasia of metastatic renal origin. Extension studies were performed with findings of pulmonary nodules that suggested metastatic disease and with a finding of right renal mass. Radical nephrectomy is performed confirming the diagnosis of renal cell carcinoma subtype clear cells. A review of the literature was carried out, which shows that a skin lesion may be the first symptom of an internal neoplasm, with breast cancer being the most frequent one reported in the literature in cutaneous metastases. The finding of a posttraumatic injury to the scalp as the first sign of a clear cell carcinoma of renal origin is very rare. The diagnosis of skin metastases requires a histopathology and immunohistochemistry study, which must be timely because it may be the first link in the research chain to detect an occult neoplasm. In conclusion, the surgeon who faces a soft tissue tumor on the scalp must consider the characteristics of the lesion, the patient’s risk factors in an articulated way that allows him to suspect malignancy in a skin lesion and that allows him diagnose a previously unknown and asymptomatic neoplasm.