Scalp Metastasis from Thyroid Carcinoma 12 Years Post-thyroidectomy: Clinical and Ethical Lessons

Aim: We describe a rare presentation of thyroid carcinoma, to highlight thyroid carcinoma in the differential diagnosis of skin lesions; and emphasize the importance of efficient record keeping in patient management.

Presentation of Case: A 73 year old man who presented with an occipital scalp nodule. This solitary skin lesion was the presenting symptom of the recurrence of a thyroid tumor surgically treated 12 years earlier. All records of the initial presentation and treatment could not be retrieved. Immunohistochemistry of the scalp lesion confirmed a thyroid carcinoma. Further examination revealed nodules in the thyroid bed, liver and lung metastases. He was referred for radio iodine therapy.

Discussion: Recurrences of thyroid carcinoma are common and can occur several years after initial diagnosis. Our patient presented with a scalp metastasis 12 years post thyroidectomy. The non-availability of the patient’s medical records makes it difficult to evaluate the management of the patient at initial presentation, and the follow up period.

Conclusion: Thyroid lesions in elderly males are more likely to be cancerous, and can recur several years after initial treatment. Proper investigation, efficient record keeping and, long term follow-up is advocated.