An Unusual Presentation of Renal Carcinoma

The clinical manifestations of renal carcinoma are many and varied. We describe here a patient who presented with skin metastases.

Case Report A 65-year-old man was referred in January 1977 with a 3-month history of a warty growth on his scrotum. This was his only symptom when he was first seen. On exami- nation there was a 1.5 cm diameter ulcerated lesion, grey in colour in the scrotal skin (Fig.), at the base of which were 3 red-purple pedunculated nodules. There was a similar nodule on his upper lip. Excision biopsy

Fig.

of these nodules was performed in February 1977. The histological appearance was typical of renal cell carci- noma (clear cell type), although at the time diagnoses of pyogenic granuloma, kerato acanthoma and amelanotic melanoma were entertained. Subsequent IVP, ultra- sound and arteriogram confirmed the diagnosis of renal cell carcinoma. Nephrectomy was performed on the 15 March 1977. The tumour was confined within the kidney capsule.

Discussion In a review of 309 cases Skinner et al. (1971) noted that 10% of patients presented with clinical symp- toms secondary to their metastases. However, the commonest sites for metastases were lung, bone, regional nodes and liver in that order. Cutaneous metastases occur in about 3% of all cases of renal tumours (Scorer, 1951), and in a post-mortem study by Hajdu and Thomas (1967) no skin meta- stases were noted. Rarely is a skin nodule the first manifestation of the disease.

Acknowledgement We would like to thank Mr Philip Powley for permission 10 publish details of a patient under his care.

References Hajdu, S. E and Thomas, A. G. (1967). Renal cell carcinoma

at autopsy. Journal of Urology, 97, 978-982. Scorer, C. G . (1951). Cutaneous metastases from renal

neoplasms. British Journol of Urology, 23, 250-259. Skinner, D. G., Colvin, R. B., Vermillion, C. D. el al.

(1971). Diagnosis and management of renal cell carcinoma. A clinical and pathologic study of 309 cases. Cancer, 28, 1165-1 177.

The Authors Anthony Ward, Kent and Canterbury Hospital, Kent. Neil Soni, Department of Surgery, Princess Margaret

Hospital, Swindon.

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