Cutaneous Metastasis Presenting as Forehead Mass

Abstract

Rapidly enlarging cutaneous masses in older patients often suggest primary skin malignancies but may represent cutaneous metastases from visceral cancers, posing diagnostic challenges. We report the case of a 72-year-old Filipino male who presented with rapidly progressive, erythematous to violaceous nodules on the forehead initially clinically suggestive of Merkel cell carcinoma. Histopathology revealed poorly differentiated dermal carcinoma lacking epidermal connection. Immunohistochemistry excluded primary cutaneous and adnexal malignancies, raising the suspicion for metastatic disease. Subsequent imaging demonstrated extensive systemic involvement consistent with metastatic renal carcinoma. Cutaneous metastases to the head and neck are rare and may serve as the initial manifestation of advanced visceral malignancy. This case highlights the diagnostic challenge posed by cutaneous metastases mimicking cutaneous malignancies, particularly in resource-limited settings. A high index of suspicion, careful clinicohistopathological correlation, strategic use of immunohistochemistry, and timely multidisciplinary evaluation are essential, as early recognition of cutaneous metastases carries significant diagnostic, prognostic, and palliative implications.