Acrometastasis as an Initial Sign of Progression in Untreated Metastatic Renal Cell Carcinoma: A Case Report.

Acral metastases are an exceptionally uncommon manifestation of bone dissemination, with renal cell carcinoma (RCC) serving as a particularly rare primary source. Historically, these lesions signified terminal disease managed with palliative amputation, although most data predate modern immunotherapy. A man in his 50s presented with newly diagnosed clear cell RCC, an inferior vena cava tumor thrombus, and bilateral lung metastases. He repeatedly declined systemic immunotherapy. Nine months later, he developed a painful swelling of the right ring fingertip. Imaging revealed an osteolytic lesion of the distal phalanx. Amputation was performed, and histopathology confirmed metastatic RCC. This case illustrates an atypical acral metastasis secondary to untreated, naturally progressing systemic disease. It highlights the challenges of patient autonomy and traditional medicine preferences. It emphasizes the role of local surgery for symptom relief and histological verification and underscores the necessity of a highly individualized, multidisciplinary approach to managing rare metastatic presentations.