Skin metastasis as incidental finding in follicular epithelium derived – thyroid cancer

Skin metastases are not typical. Malignancies like mammary cancer (most frequent in females) and pulmonary neoplasia (most frequent in males) represent the majority and exceptional findings are in those originating from thyroid, prostate, ovaries and oesophagus, usually in advanced, generally disseminated stages, with a poor prognosis. It may be found more often in elderly patients. We aim to present some practical aspects of skin metastases in thyroid cancer that originates from follicular thyroid epithelium. This is a brief literature review. The level of evidence is poor since most data is provided from cases reports. Cutaneous malignant lumps are rarely the first sign of disease, mostly associating a cancer relapse. The location varies from neck and head (majority) to exceptional sites as chest wall and of variable rate for scalp. Underling neck muscle or Meckel’s cave metastasis may be associated. The lesion is usually a lump of medium to small size, sometimes of papular appearance, without local pain (but depends on the site); it may associate erythema. The diagnosis is difficult unless an index of suspicion is positive (in which case whole body radioiodine scintigram may be useful). Biopsy and histological report are essential for diagnosis especially in cases without an evident connection to a prior/synchronous thyroid malignancy. Knowing the exceptional prevalence, the need for awareness in this particular topic is connected with a multidisciplinary daily practice