Metastatic renal cell carcinoma to the earlobe 27 years after nephrectomy

We present a case of a nodule on the earlobe of an elderly patient, without any known clinical history. Microscopic examination revealed a tumor with morphology reminiscent of metastatic clear cell renal cell carcinoma. The results of an extensive immunohistochemical (IHC) examination confirmed our initial diagnosis and further investigation of the patient's medical history revealed that a unilateral nephrectomy had been performed 27 years prior to the current tumor. We are reporting this case to emphasize the long interval between the primary tumor and its metastasis in an extremely unusual site, with a brief discussion on the ability of this particular neoplasm for extremely late metastasis to any site on the human body. Also, we are highlighting the extensive step-by-step IHC examination to confirm the diagnosis in routine pathology.