[Scalp metastasis as the first manifestation of mixed follicular-papillary thyroid cancer].

Distant metastases are a rare occurrence in differentiated thyroid cancer, and when detected in skin, often arise in the context of disseminated disease after many years of progression since diagnosis. This study presents the case of a 77-year-old female without known thyroid disease, who presented with metastases in the parieto-occipital scalp region, in which thyroid tissue was identified. Thyroid ultrasound identified a nodule reported as a follicular tumour and preoperative investigation of tumour spread was negative. Total thyroidectomy plus central lymph node dissection were performed and histopathology reported mixed papillary-follicular carcinoma without lymph node metastasis. Lung micrometastases were detected in the post-I131 whole-body scan (104.7 mCi dose), and two months after a second dose of 131I (125 mCi), thyroglobulin was undetectable. Thyroid cancer should be included in the differential diagnosis of cutaneous metastases, since with early diagnosis and treatment, prognosis is generally more favourable than in other solid tumours.