Painful leg mass
The moist purple exophytic lesion on the patient’s lower leg prompted him to seek care. Unfortunately, it was just the tip of the iceberg.
Skin metastases in RCC may be mistaken for other skin lesions, such as pyogenic granulomas, melanomas, or dermatofibromas.5 Histopathological analysis (and sometimes even special immunohistochemical staining and cytogenic analysis) can be used to make a definitive diagnosis.
Management options include radical nephrectomy
Treatment options and the prognosis for RCC are dependent on the extent of disease involvement at diagnosis. Radical nephrectomy is the gold standard therapy for patients with local, locally advanced, and even minimally metastatic disease.6
Other therapies include immunotherapy, interferons, interleukins, and gene therapy.6 Chemotherapy and radiation therapy have a limited role, as RCC is generally resistant to them. However, with more advanced metastatic disease, most treatment is palliative. The median survival time after diagnosis of metastatic RCC is about 20 months.6
Patient opts for treatment, then discontinues it
My patient was transferred to a local hospital with oncology support for further evaluation and management. He was ultimately diagnosed with metastatic renal carcinoma with bony, cutaneous, liver, and lung metastases. His hospital course was complicated by the development of hematuria and anemia, which required additional blood transfusions.
The patient was initially started on immunotherapy with sorafenib but upon acceptance of his metastatic disease and poor prognosis, he opted to discontinue therapy and enter an inpatient hospice facility.
CORRESPONDENCE Lesli M. Lucas, MD, Naval Branch Health Clinic Dahlgren, 17457 Caffee Road, Dahlgren, VA 22448; lesli.lucas@med.navy.mil
