CLINICAL CASE:

A 60-year-old man sought medical attention for a painful, hypersensitive neoformation of 3-month progression located at the occipital region of the scalp, that bled easily upon manipulation. Physical examination revealed normal vital signs. A 4 x 4 x 3-cm soft, erythematous, slightly mobile, well-defined sphere-shaped tumor was observed at the occipital region, with alopecia. It had regular edges and a serohematic scab at its center and was painful upon palpation. The lesion was suggestive of a trichilemmal or pilar cyst, but ultrasound study identified a solid tumor with heterogeneous echogenicity and Doppler imaging showed vascularization. The histopathologic report stated neoplasia with a morphologic pattern consistent with metastatic clear cell renal cell carcinoma. Postoperative tomography showed the coexistence of a tumor in the right kidney, with radiologic characteristics of stage IV clear cell renal cell carcinoma (T4N1M1) and multiple solid nodular lesions consistent with bilateral pulmonary parenchymal metastasis. The patient developed end-stage renal disease and decided to discontinue treatment. He had important deterioration in his general state of health and died shortly thereafter from disseminated metastatic disease.

CONCLUSIONS:

Metastasis to the scalp can simulate a trichilemmal cyst and be accompanied by neoplastic alopecia. Cutaneous metastases from clear cell renal cell carcinoma are difficult to identify because they resemble common dermatoses, resulting in a low rate of suspicion. They are a sign of poor prognosis, given that they suggest the involvement of multiple organs.

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