Dermatology: Practical and Conceptual Image Letter | Dermatol Pract Concept. 2025;15(3):5440 1 Atypical Cutaneous Metastasis in Clear Cell Renal Carcinoma Amanda do Carmo Gusmão1, Carollina Cecim De Souza1, Luciana Pantaleão1, Isadora Ortiz Cantarino Pereira da Silva1, Bruno de Souza Bianchi Reis1, Carlos Arthur de Figueiredo Athayde1 1 Department of Dermatology of Federal Fluminense University, Brazil Citation: Gusmão AC, De Souza CC, Pantaleão L, et al. Atypical Cutaneous Metastasis in Clear Cell Renal Carcinoma. Dermatol Pract Concept. 2025;15(3):5440. DOI: https://doi.org/10.5826/dpc.1503a5440 Accepted: April 30, 2025; Published: July 2025 Copyright: ©2025 Gusmão et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing Interests: None. Authorship: All authors have contributed significantly to this publication. Corresponding Author: Carollina Cecim de Souza, MD, Department of Dermatology of Federal Fluminense University, Brazil. E-mail: carollcecim@hotmail.com Case Presentation A 73-year-old male patient presented for consultation with a complaint of an “infected cyst” on the left dorsal region, persisting for over six months and refractory to antibiotic treatment. His medical history included a radical nephrec- tomy of right kidney for clear cell renal carcinoma (ccRCC) two years prior, currently on adjuvant Pazopanib. Two years after surgery, examination revealed a 5×4 cm erythematous, non-inflammatory tumor on the left dorsal region. Dermoscopy showed prominent linear branched nonfocus vessels, scales, and white structureless areas. The ultrasound presented a solid, heterogeneous nodule in the subcutaneous tissue at the dorsolumbar spine measuring 5.5 × 4.6 cm. Doppler imaging showed intense intralesional vas- cularization with low-resistance flow. Histopathologi- cal analysis confirmed carcinoma involving the dermis. Immunohistochemical analysis showed positivity for PAX-8, RCC and TTF-1 and was negative for CK7, CK20, CD34, HSV8, S100, PSA, and CDX2, establishing the diagnosis of metastatic carcinoma originating from a renal primary site. Palliative radiotherapy (25 Gy/5fx) and nivolumab were proposed. The patient has pulmonary and bone metastases but remains in good condition, despite a guarded prognosis. Teaching Point Cutaneous metastases are rare in ccRCC, occurring in 2.8–6.8% of cases, with a median survival of six months [1,2]. They typically present as rapidly growing nodular le- sions, ranging in color from skin-toned to red-purple, and are often located on the face, scalp, chest, and abdomen [2]. It is crucial to maintain heightened vigilance for atypical lesions in patients with a history of malignancy, as cutaneous me- tastases may manifest in uncommon characterized patterns. 2 Image Letter | Dermatol Pract Concept. 2025;15(3):5440 References 1. Ferhatoglu MF, Senol K, Filiz AI. Skin Metastasis of Renal Cell Carcinoma: A Case Report. Cureus. 2018;10(11):e3614. Published 2018 Nov 19. DOI:10.7759/cureus.3614. PMID: 30680270. 2. Souza BCE, Miyashiro D, Pincelli MS, Sanches JA. Cutaneous me- tastases from solid neoplasms - Literature review. An Bras Der- matol. 2023;98(5):571-579. DOI:10.1016/j.abd.2022.10.009. PMID: 37142464. Figure 1. A) Erythematous tumor lesion approximately 5×4 cm in size located on the left dorsal region; B) Dermoscopy showing prominent linear branched nonfocus vessels, scales, and white structureless areas; C) Histological section showing infiltration of neoplastic cells in the dermis (Hematoxilin&Eosin, 40x, original magnification); D) Immunohistochemical examination showing neoplastic cells positive for the anti-Pax-8 antibody, confirming re- nal origin (40x, original magnification).