Sir, a 69-year-old gentleman was referred to us by his GP complaining of swelling under his eye for six weeks that had been increasing in size. He also described a lump in the palate which had developed ten days prior to presentation at the clinic and which was now getting bigger. He had an associated facial swelling. There was no visual disturbance, no pain and no paraesthesia. Six months earlier he had a left nephrectomy due to renal cell carcinoma (RCC). Clinical examination ruled out a dental cause. A CT scan showed a large soft tissue mass centred on the right maxillary antrum extending superiorly to involve the floor of the orbit and posteriorly to involve the right infero-temporal fossa, medially to involve the ethmoid air cells and nasal cavity. An incisional biopsy of the maxilla showed RCC metastasis. RCC is the third most common cause of distant metastases to the head and neck region.1 In patients with a known history of RCC, it is therefore necessary to regard head and neck lesions with a high index of suspicion for malignancy.2

Figure 1
figure 1

15 mm soft, raised, left palatal lesion

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