“Thumb’s off” for acrometastasis of renal cell carcinoma: Is there a role for acrometastasectomy in the era of targeted therapy?

Dear Editor,Malignant tumours of the hand are relatively uncommon.Acrometastasis,defined as metastatic bone lesions of the hand or feet are exceedingly rare,with a reported incidence rate of between 0.007%and 0.2%of all metastatic lesions[1].Acrometastasis of metastatic renal cell carcinoma(mRCC)accounts for only 10%e12%of the reported cases with majority of cases originating from primary lung cancer.The presentation poses a diagnostic and management dilemma and is usually delayed as the symptoms and signs are similar to infective or benign conditions.Typically the prognosis is grim[2,3].In this rarest of rare cases,we report a patient of renal cell carcinoma(RCC)with metastasis to the right shoulder and acrometastasis of the right thumb.We highlight the multidisciplinary team approach utilized and the management by multimodal therapy to achieve the best palliative outcome.