Figure 528

Metastatic malignant melanoma involving the kidney. The urinary tract is a common site of melanoma metastases. If not amelanotic, the metastatic nodules are brownish black. Metastatic infiltration of the kidneys is often an incidental finding at autopsy but is a rare cause of functional impairment [68]. Most renal metastases are multiple and bilateral. Glomeruli tend to be spared, possibly because of their lack of lymphatic channels. Pulmonary carcinoma is the most commonly reported form of metastatic solid tumor involving the kidneys, followed by metastatic stomach and breast carcinoma [69].

Metastatic melanoma is an example of a tumor that may be transplanted at the time of cadaver kidney transplantation, with subsequent rapid proliferation in the immunosuppressed recipient; tumor rejection may occur with cessation of immunosuppressive therapy [70] (see Fig. 5-37). The presence of renal metastases is often overlooked during life due to the absence of any specific physical or laboratory findings. The laboratory finding most likely to occur is hematuria due to tumor erosion of intrarenal vessels. (From Skarin [31]; with permission.)

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