Skip to main content
NCBI home page
World Journal of Otorhinolaryngology - Head and Neck Surgery logoLink to World Journal of Otorhinolaryngology - Head and Neck Surgery
. 2026 Jun 26:10.1002/wjo2.70128. Online ahead of print. doi: 10.1002/wjo2.70128

Papillary Thyroid Cancer With Cutaneous Metastasis: A Case Report and Literature Review

Yi‐Qing Gao 1, Xin‐Lu Yin 1,✉, Lu‐Ying Zheng 2, Jia‐Dong Wang 1
PMCID: PMC13399409  PMID: 42500096

ABSTRACT

Background

Cutaneous metastasis of papillary thyroid carcinoma is rare, which may present as slowly growing nodules, erythematous papules, or ulcerative nodules. The pathophysiological mechanisms of skin metastasis in thyroid cancer remain unclear. Skin metastasis of thyroid papillary carcinoma represents a poor prognostic factor in previous studies, and whether there exist relative genes still needs to be further investigated.

Summary

Eight years after a radical surgery for left‐sided thyroid cancer, a 29‐year‐old female presented to our dermatology department after discovering a patch of hyperpigmentation on the right side of her neck for 2 years. The dermatologist performed a biopsy of the neck skin mass under local anesthesia, and the gross specimen consisted of a piece of skin tissue measuring 0.4 cm × 0.3 cm × 0.3 cm, with a gray‐black area of 0.4 cm on the surface. Microscopic examination, along with the clinical history, suggested metastasis of papillary thyroid carcinoma. Further immunohistochemical analysis showed results consistent with metastasis of papillary thyroid carcinoma, with tumor cells expressing TTF‐1 (positive), TG (−), Ki67 (−), PAX‐8 (+), GCDFP (−), ER (−), PR (20%), and GATA‐3 (−).

Conclusion

Skin metastases account for a relatively small proportion of metastatic thyroid cancer and can be easily misdiagnosed. Patients with skin lesions, especially in the head and neck area, that appear during the follow‐up of thyroid cancer should be carefully selected and diagnosed.

Keywords: immunohistochemistry, papillary thyroid cancer, skin metastasis

1. Introduction

The incidence of thyroid cancer in the population is approximately 1.2%, and the incidence of thyroid tumors has remained stable since 1970, with an overall incidence being three times higher in women than in men [1]. Among these, papillary thyroid carcinoma is the most common type of malignant thyroid tumor in both adults and children, with an incidence of approximately 80%–90% of all primary thyroid tumors [2, 3, 4]. The prognosis for patients with papillary thyroid cancer is generally favorable with appropriate treatment, with a 10‐year overall survival rate usually exceeding 90%. However, local recurrence of the cancer occurs in approximately 5% of patients with papillary thyroid cancer [5, 6, 7].

Previous studies have shown that distant metastasis of papillary thyroid carcinoma is rare, accounting for about 1%–4% of cases [8, 9]. Metastases typically involve lymph nodes, lungs, and bones, while skin metastasis from papillary thyroid carcinoma is uncommon [10, 11], representing 0.7%–2.0% of all skin malignancies [12, 13]. Previous research indicates that among skin metastases of thyroid cancer, papillary carcinoma is the most common (41%), with the scalp being the most frequent site of metastasis, and the average survival time after being diagnosed with skin metastasis is 19 months [14].

Therefore, we report a case of a patient with skin metastasis of papillary thyroid carcinoma, which occurred 8 years after surgery and regular follow‐up. We present the clinical, histopathological, and immunohistochemical results and review the relevant literature to explore the significance of thyroid cancer in the differential diagnosis of atypical skin lesions.

2. Case

A 29‐year‐old female presented to our dermatology department after discovering a rash on the right side of her neck for 2 years. Physical examination revealed a brown papule on the right side of her neck, slightly erythematous at the base, approximately the size of a mung bean. The patient had no relevant family history or history of radiotherapy. Eight years prior, during a routine health check, she was found to have a thyroid nodule and visited our hospital within a month. The patient reported no pain, dyspnea, hoarseness, fever, chest tightness, tremor, or swelling of the limbs, or convulsions, and there was no significant growth or decline of the mass during the course of the disease. A thyroid ultrasound showed a hypoechoic nodule with calcification in the left lobe of the thyroid (TI‐RADS 4a) and a mixed echogenicity nodule in the right lobe (TI‐RADS 3), with no significantly enlarged lymph nodes observed in both sides of the neck. Preoperative fine‐needle aspiration of the 1 cm nodule in the left lobe revealed follicular epithelial cells in small clusters, with crowded nuclei and atypia, showing some nuclear grooves, suggestive of papillary thyroid carcinoma. Preoperative chest radiograph and nasopharyngolaryngoscopy did not reveal any significant abnormalities.

In September 2016, the patient underwent a left thyroid lobectomy, isthmus thyroidectomy, and central lymph node dissection in our hospital. Intraoperative frozen section and postoperative paraffin pathology confirmed left‐sided papillary thyroid carcinoma with a maximum diameter of 0.7 cm and a colloid nodule in the right lobe (Figure 1). Lymph nodes in the VI region showed metastasis of papillary thyroid carcinoma (2 out of 3). The patient was followed up regularly postoperatively and received levothyroxine thyroid suppression therapy (Figure 2).

Figure 1.

Figure 1

Open in a new tab

Hematoxylin and eosin staining of the left‐sided papillary thyroid carcinoma of the patient.

Figure 2.

Figure 2

Open in a new tab

The patch of hyperpigmentation on the right side of the patient's neck. (A) The patch of hyperpigmentation in July 2022. (B) In September 2022. (C) In January 202. (D) In March 2023.

In December 2024, during a follow‐up visit at our department, the patient was taking two tablets of levothyroxine a day. Thyroid function tests showed: fT3 3.98 pmol/L, fT4 16.50 pmol/L, TSH 2.84 µIU/L, TG 2.98 ng/mL, TGAb 17.70 IU/mL, and TPOAb 12.60 IU/mL. Thyroid ultrasound indicated postoperative changes with no significant abnormalities in the residual gland, and there were also no significant abnormalities in the bilateral parathyroid region and no enlarged lymph nodes in the bilateral neck and supraclavicular area.

At the same time, the patient was consulted in dermatology for the discovery of a patch of hyperpigmentation on the right‐sided neck, which at first was thought to be a simple mole. A dermatologist performed a biopsy of the neck skin mass under local anesthesia, and the specimen was sent to pathology after the operation. The gross specimen consisted of a piece of skin tissue measuring 0.4 cm × 0.3 cm × 0.3 cm, with a gray‐black area of 0.4 cm on the surface. Microscopic examination, along with the clinical history, suggested metastasis of papillary thyroid carcinoma (Figure 3a). Further immunohistochemical analysis showed results consistent with metastasis of papillary thyroid carcinoma, with tumor cells expressing TTF‐1 (+), TG (−), Ki67 (−), PAX‐8 (+), GCDFP (−), ER (−), PR (20%), and GATA‐3 (−) (Figure 3b–d). Three months after the skin operation, the patient paid a follow‐up visit to the clinic (Figure 4).

Figure 3.

Figure 3

Open in a new tab

Pathology and immunohistochemical results after the excisional biopsy of skin metastasis from the patient. (A) Hematoxylin and eosin staining of the cutaneous nodule shows a metastasis of papillary thyroid carcinoma. (B) Skin metastasis demonstrated positivity for PAX‐8. (C) Skin metastasis demonstrated positivity of polyclonal immunoperoxidase staining for thyroglobulin. (D) Skin metastasis demonstrated positivity for TTF‐1.

Figure 4.

Figure 4

Open in a new tab

Three months after the excision of the skin metastases.

In January 2026, we conducted a follow‐up with the patient with thyroid ultrasound, thyroid function, and a CT scan of the chest. Thyroid function tests showed: fT3 4.72 pmol/L, fT4 19.80 pmol/L, and TSH 0.037 µIU/L. Thyroid ultrasound indicated postoperatively for thyroid, the gland showed normal echogenicity, even distribution, and normal echo intensity. Color Doppler flow imaging revealed increased blood flow signals. A hypoechoic nodule measuring 5.5 mm × 3.8 mm was observed in the left neck root, area Ⅵ, anterior to the carotid artery, with clear boundaries, regular morphology, and a distinct corticomedullary differentiation. No mass was currently visualized in the right parathyroid region. No significantly enlarged lymph nodes were currently seen in the bilateral neck regions and supraclavicular regions. The CT scan showed two tiny nodules in the lower lobes of both lungs, and a tiny ground‐glass nodule was noted in the upper lobe of the left lung, which remained stable compared to the previous CT scan (dated December 20, 2023). The patient now takes levothyroxine of 1.5 tablets a day. We recommend that she have a follow‐up of thyroid function every 3 months, a thyroid ultrasound every 6 months, and a CT scan of the chest every year.

3. Discussion

3.1. Epidemiology

Papillary thyroid carcinoma is the most common pathological subtype of malignant thyroid tumors, commonly known for local lymph node metastasis rather than distant metastasis. A systematic review conducted by Madani et al. [15] reported the rare metastases of differentiated thyroid cancer (57% for papillary carcinoma, 39% for follicular carcinoma, and 4% for Hurthle cell carcinoma), which found that in 42 case series and 197 case reports, the incidence of brain metastasis was 44%, followed by skin metastasis at 17% and liver metastasis at 8%. Skin metastasis in thyroid papillary carcinoma is a unique manifestation, with nearly all such occurrences happening in the head and neck region [14]. Cutaneous metastatic carcinoma may present as slowly growing nodules, erythematous papules, or ulcerative nodules. As seen in our reported case, these lesions may often be asymptomatic, leading to potential misdiagnosis [10, 14, 16]. Although thyroid papillary carcinoma is not rare, occasional skin metastasis may represent the initial manifestation of occult thyroid cancer [12].

Recent literature review showed [17] that 136 cases of skin metastasis from thyroid cancer have been identified in the literature from 1966 to 2023, with patients aged 21–95 years old, with an average age of 63.13 years old, and a slightly higher prevalence in females (n = 75/136, 55.15%) compared to males (n = 61/136, 44.85%). Among these, 121 patients reported a more specific time interval between the two diagnoses, averaging 48.27 months. The case we reported involves a young female patient who developed skin metastases 8 years post‐surgery, further emphasizing the importance of raising awareness among patients and physicians for timely diagnosis and management.

3.2. Pathophysiological Mechanisms

Currently, the pathophysiological mechanisms of skin metastasis in thyroid cancer remain unclear. Some previous studies [18] suggested that skin metastases from thyroid cancer were often limited to the upper body, particularly the scalp and face, as these areas have a rich dermal capillary network, providing an ideal site for metastasis.

However, other studies have suggested that thyroid nodules might be ruptured during surgery or that fine‐needle aspiration biopsy (FNAB) could cause needle track metastasis, potentially leading to skin contamination and subsequent metastasis [14, 19, 20].

For example, Soylu et al. [21] reported two cases of patients with skin metastasis who had previous surgery at different centers, suggesting that skin contamination might be the cause of the skin metastasis. There are also studies indicating that skin nodules could be a result of needle track implantation [22]. They identified several cases of needle track implantation after diagnostic thyroid FNAB. In one study, among 4912 patients diagnosed with PTC after FNAB, seven cases (0.14%) showed needle track implantation of PTC [23].

But as for our patient, she has accepted an FNAB in the left lobe of the thyroid gland, while the implantation appeared on her right neck, so FNAB might not be the main reason for her metastasis. What's more, we found that her TSH in December 2024 is 2.84 µIU/L, but according to guidelines, TSH levels should be maintained in the low‐normal range (0.5–2 µIU/mL) [24, 25]. Previous study found that sustained suppression of TSH (0.05 µIU/L) was associated with longer relapse‐free survival compared with serum TSH levels consistently at 1 µIU/L or higher, and that the degree of TSH suppression was an independent predictor of relapse [26, 27]. Thus, we considered that her cutaneous metastases might be related to her unsatisfactory TSH suppression therapy.

3.3. Relative Genes

PTC is commonly associated with BRAFV600E mutations. Erickson et al. [28] evaluated 11 patients with PTC and 5 patients with follicular thyroid carcinoma (FTC) who had metastasized to the skin. They found that among the 11 PTC cases, 5 tested positive for the BRAFV600E mutation (T1799A), while none of the 5 FTC cases showed this mutation. Although the BRAFV600E mutation may be associated with more aggressive features [29], it is quite common in both cured PTC and even PTMC patients. Therefore, the high proportion of BRAFV600E mutations found in PTC patients with skin metastasis may also be due to selection bias. Thus, further studies are still needed to verify whether there is a causal relationship between the BRAFV600E gene and the occurrence of skin metastasis in PTC.

Previous meta‐analyses have shown that the concomitant occurrence of TERT promoter mutations and BRAFV600E alterations is a strong indicator of aggressive disease behavior [30]. In thyroid cancer, h‐TERT mutations are typically found in FTC and are associated with more aggressive and advanced disease [31]. In a case reported by Monti et al. [32], a patient with FTC who experienced skin metastasis demonstrated two coexisting mutations, a NRAS Gln61Arg mutation co‐occurring with the TERT mutation, while both TERT and NRAS mutations were significantly absent in the primary tumor. Although there have been no reports on TERT mutations in PTC patients with skin metastasis, TERT promoter mutations are predictive factors for aggressiveness and poorer prognosis, and the biological and clinical significance of this association remains to be further investigated.

In summary, since these mutations may lead to metastasis, and genomic analysis will promote the development of targeted therapies, further research is needed to identify the genes that cause PTC to exhibit more aggressive behavior.

3.4. Immunohistochemistry

TTF‐1 is a DNA‐binding protein containing a 38 kDa homeodomain that was first discovered in thyroid follicular cells and subsequently found in lung cells and thyroid C cells [33]. Analysis of previous studies has indicated that DTC patients with higher TNM staging, lower differentiation, PTC histotype, and lymph node metastasis have a higher positive expression rate of TTF‐1. The 3‐year overall survival rate for TTF‐1‐negative DTC patients was found to be higher than that of TTF‐1‐positive DTC patients [34]. In a previous case report, an 82‐year‐old male developed a painful 4 cm subcutaneous nodule in the neck 11 years after treatment for PTC [12], and pathological examination revealed that the lesion was metastatic PTC with strong TTF‐1 positivity. Similarly, the case we reported also demonstrated TTF‐1 positivity.

Thyroglobulin (Tg) is a large protein consisting of 2750 amino acids with a molecular weight of 330 kDa that is synthesized and secreted by the follicular epithelial cells of the thyroid gland [35], and serum Tg serves as a valuable marker for monitoring residual, recurrent, and metastatic tumors in patients with post‐total thyroidectomy DTC, especially those treated with 131I [25]. Doutre et al. [36] reported the case confirmed by immunoperoxidase studies using monoclonal anti‐thyroglobulin antibody. Similarly, Lissak et al. [37] suggested that when the classical histological examination of a skin metastasis is doubtful, demonstrating TG in the tumor may be helpful.

The cases reported by Khan et al. [38] and Arat et al. [39] both confirmed tumor cells positive for TTF‐1 and Tg in the metastatic skin lesions of their patients. While in our case, the immunohistochemistry showed only positive for TTF‐1 but negative for Tg.

3.5. Treatment and Prognosis

Based on the literature, surgical resection can be a therapeutic option [40, 41, 42], as well as molecular targeted therapy or radioactive iodine treatment [19, 43]. Most patients with cutaneous metastases undergo surgical resection [44] as the choice made by our patient. On the other hand, Li et al. [40] argued that the feasibility of surgery remained to be further discussed due to the high rates of complications and mortality. Kwon et al. [22] reported a case of a PTC patient developing skin metastases 3 years post‐surgery, who underwent resection of a subcutaneous 0.4 cm metastatic lesion, which was confirmed as thyroid cancer metastasis. Eight months later, a new nodule appeared at the previous resection site, and pathology confirmed it as deep dermal metastatic PTC, which was again resected with clear margins.

Other treatment options include radioactive iodine, appropriate levothyroxine suppression therapy, and localized external radiation therapy [14]. Monti et al. [32] suggested that early administration of two doses of RAI treatment may lead to a more favorable prognosis. The patients reported were able to survive after two doses of RAI while remaining in good health and completely asymptomatic. After receiving a third course of RAI treatment, it was found that her distant metastatic tumors remained stable, and her unstimulated Tg level was 277 µg/L, leading them to conclude that RAI treatment remained the most effective postoperative therapy. In the case presented by Farina et al., Sorafenib was used as a molecular targeted therapy [19].

But, as recommended by the clinical guideline of the Japan Associations of Endocrine Surgeons [45], in differentiated thyroid carcinoma, the decision for the use of RAI therapy should be made after thorough consideration of disease progression as well as location, number, and size of recurrent lesions. RAI is also not recommended for metastasis to other organs except the bone and lung. As evidence, they found that, as an adverse event, the incidence of blood system disorders was reported as 37%, and that there were no reports inquiring about the patients’ perspective. What's more, the molecular target medicine was recommended for definitely progressive DTC refractory to RAI therapy by several guidelines [24, 45, 46, 47]. But the Japanese guideline also mentioned that the use of molecular target therapy was reported to be associated with serious complications such as serious or even fatal bleeding in patients with invasion to the artery or the skin, which makes it not indicated for such patients, especially for those having skin invasion [45]. We've also found other case reports [22, 48, 49, 50], in which patients with a skin metastasis accepted a local surgery, and they recommended that the treatments for skin metastasis of PTC could be chosen between surgical resection for isolated skin metastasis, which may be successfully treated, and treatment with radioiodine therapy, external beam radiation therapy, or targeted therapy for those with systemic disease. Thus, as for our patient, who is still young and conducts a regular follow‐up, we suggested a PET‐CT scan and an isolated surgical resection instead of a total thyroidectomy and RAI in order to avoid the risks of damage to adjacent organs and nerves from reoperation, the side effects of RAI, and to preserve the function as much as possible. In the future, we will still insist on regular surveillance with both ultrasound for the residual contralateral thyroid lobe and cervical lymph node, and also a CT scan for the lung and other organs.

When distant metastasis occurs, the prognosis for the disease is poorer [14]. Skin metastasis of thyroid papillary carcinoma is also a poor prognostic factor. Shon et al. [16] and Aghasi et al. [51] suggested that the appearance of skin metastases tended to indicate a poor prognosis, as their presence is indicative of aggressive disease and dissemination, with an average life expectancy of less than 1 year post‐diagnosis. Coming to an agreement, Sciscent et al. found that among 34 patients with known overall survival times, the average survival time was 13.07 months [17]. In contrast, all patients in the study by Farina et al. survived for 2–4 years after surgical removal of skin metastases [19]. Other studies have also indicated [22] that in most cases, tumor seeding can be surgically removed without recurrence, and there is no significant correlation between tumor seeding and prognosis in PTC [23, 49].

4. Conclusion

In conclusion, skin metastases account for a relatively small proportion of metastatic thyroid cancer and can be easily misdiagnosed. However, this possibility should be considered in patients with skin lesions, especially in the head and neck area, that appear during the follow‐up of thyroid cancer, even if it is a single skin nodule. A thorough examination, biopsy, and immunostaining should be performed, and treatment should be carefully selected. More research is needed in the future to focus on the risk factors for postoperative skin metastasis in thyroid cancer, to uncover genes associated with skin metastasis, and to explore the most appropriate treatment modalities for patients with different skin metastases.

Author Contributions

Yi‐Qing Gao collected the information and wrote the original draft. Xin‐Lu Yin and Jia‐Dong Wang reviewed and edited the draft. Lu‐Ying Zheng prepared and validated the pathological sections.

Ethics Statement

The authors have nothing to report.

Consent

Informed consent was obtained from the patient prior to the writing of this manuscript.

Conflicts of Interest

The authors declare no conflicts of interest.

Acknowledgments

This study was supported by the Bethune Charitable Foundation (Grant Z04J2024E107‐B‐13).

Data Availability Statement

The authors have nothing to report.

References

  • 1. Siegel R. L., Miller K. D., Wagle N. S., and Jemal A., “Cancer Statistics, 2023,” CA: A Cancer Journal for Clinicians 73, no. 1 (2023): 17–48. [DOI] [PubMed] [Google Scholar]
  • 2. Lam A. K. Y., Lo C. Y., and Lam K. S. L., “Papillary Carcinoma of Thyroid: A 30‐yr Clinicopathological Review of the Histological Variants,” Endocrine Pathology 16, no. 4 (2005): 323–330, 10.1385/ep:16:4:323. [DOI] [PubMed] [Google Scholar]
  • 3. LeClair K., Bell K. J. L., Furuya‐Kanamori L., Doi S. A., Francis D. O., and Davies L., “Evaluation of Gender Inequity in Thyroid Cancer Diagnosis: Differences by Sex in US Thyroid Cancer Incidence Compared With a Meta‐Analysis of Subclinical Thyroid Cancer Rates at Autopsy,” JAMA Internal Medicine 181, no. 10 (2021): 1351–1358, 10.1001/jamainternmed.2021.4804. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4. Xu J., Zhang Y., Liu J., Qiu S., and Wang M., “A Population‐Based Study of the Three Major Variants of Papillary Thyroid Carcinoma,” Journal of International Medical Research 49, no. 2 (2021): 300060520984618, 10.1177/0300060520984618. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5. Chatchomchuan W., Thewjitcharoen Y., Karndumri K., et al., “Recurrence Factors and Characteristic Trends of Papillary Thyroid Cancer Over Three Decades,” International Journal of Endocrinology 2021 (2021): 9989757, 10.1155/2021/9989757. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6. Cao Y. M., Zhang T. T., Li B. Y., Qu N., and Zhu Y. X., “Prognostic Evaluation Model for Papillary Thyroid Cancer: A Retrospective Study of 660 Cases,” Gland Surgery 10, no. 7 (2021): 2170–2179, 10.21037/gs-21-100. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7. Ito Y., Miyauchi A., Kihara M., Fukushima M., Higashiyama T., and Miya A., “Overall Survival of Papillary Thyroid Carcinoma Patients: A Single‐Institution Long‐Term Follow‐up of 5897 Patients,” World Journal of Surgery 42, no. 3 (2018): 615–622, 10.1007/s00268-018-4479-z. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8. Toraih E. A., Hussein M. H., Zerfaoui M., et al., “Site‐Specific Metastasis and Survival in Papillary Thyroid Cancer: The Importance of Brain and Multi‐Organ Disease,” Cancers 13, no. 7 (2021): 1625, 10.3390/cancers13071625. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9. Nunes K. S., Matos L. L., Cavalheiro B. G., et al., “Risk Factors Associated With Disease‐Specific Mortality in Papillary Thyroid Cancer Patients With Distant Metastases,” Endocrine 75, no. 3 (2022): 814–822, 10.1007/s12020-021-02901-z. [DOI] [PubMed] [Google Scholar]
  • 10. Cohen P. R., “Metastatic Papillary Thyroid Carcinoma to the Nose: Report and Review of Cutaneous Metastases of Papillary Thyroid Cancer,” Dermatology Practical & Conceptual 5, no. 4 (2015): 7–11, 10.5826/dpc.0504a03. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11. Yoon J. H., Jeon M. J., Kim M., et al., “Unusual Metastases From Differentiated Thyroid Cancers: A Multicenter Study in Korea,” PLoS One 15, no. 8 (2020): e0238207, 10.1371/journal.pone.0238207. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12. Alwaheeb S., Ghazarian D., Boerner S. L., and Asa S. L., “Cutaneous Manifestations of Thyroid Cancer: A Report of Four Cases and Review of the Literature,” Journal of Clinical Pathology 57, no. 4 (2004): 435–438, 10.1136/jcp.2003.012922. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13. de Giorgi V., Alfaioli B., Massi D., et al., “Solitary Cutaneous Metastasis as the First Sign of Relapse of Thyroid Carcinoma: A Clinical, Dermoscopic‐Pathologic Case Study,” Dermatologic Surgery 35, no. 3 (2009): 523–526, 10.1111/j.1524-4725.2009.01088.x. [DOI] [PubMed] [Google Scholar]
  • 14. Dahl P. R., Brodland D. G., Goellner J. R., and Hay I. D., “Thyroid Carcinoma Metastatic to the Skin: A Cutaneous Manifestation of a Widely Disseminated Malignancy,” Journal of the American Academy of Dermatology 36, no. 4 (1997): 531–537, 10.1016/s0190-9622(97)70239-1. [DOI] [PubMed] [Google Scholar]
  • 15. Madani A., Jozaghi Y., Tabah R., How J., and Mitmaker E., “Rare Metastases of Well‐Differentiated Thyroid Cancers: A Systematic Review,” Annals of Surgical Oncology 22, no. 2 (2015): 460–466, 10.1245/s10434-014-4058-y. [DOI] [PubMed] [Google Scholar]
  • 16. Shon W., Ferguson S. B., and Comfere N. I., “Metastatic Hürthle Cell Carcinoma of the Thyroid Presenting as Ulcerated Scrotum Nodules,” American Journal of Dermatopathology 32, no. 4 (2010): 392–394, 10.1097/dad.0b013e3181c1acaf. [DOI] [PubMed] [Google Scholar]
  • 17. Sciscent B. Y., Eberly H. W., Goyal N., and Goldenberg D., “Thyroid Cancer With Cutaneous Metastases,” Ear, Nose, & Throat Journal, ahead of print, March 14, 2024, 10.1177/01455613241239533. [DOI] [PubMed] [Google Scholar]
  • 18. Avram A. M., Gielczyk R., Su L., Vine A. K., and Sisson J. C., “Choroidal and Skin Metastases From Papillary Thyroid Cancer: Case and a Review of the Literature,” Journal of Clinical Endocrinology & Metabolism 89, no. 11 (2004. Nov): 5303–5307, 10.1210/jc.2004-0757. [DOI] [PubMed] [Google Scholar]
  • 19. Farina E., Monari F., Tallini G., et al., “Unusual Thyroid Carcinoma Metastases: A Case Series and Literature Review,” Endocrine Pathology 27, no. 1 (2016): 55–64, 10.1007/s12022-015-9410-7. [DOI] [PubMed] [Google Scholar]
  • 20. Karwowski J. K., Nowels K. W., McDougall R., and Weigel R. J., “Needle Track Seeding of Papillary Thyroid Carcinoma From Fine Needle Aspiration Biopsy,” Acta Cytologica 46, no. 3 (2002): 591–595, 10.1159/000326884. [DOI] [PubMed] [Google Scholar]
  • 21. Soylu S., Arikan A. E., Teksoz S., Ozcan M., and Bukey Y., “Skin Metastasis on the Neck: An Unusual Presentation of Recurrence of Papillary Thyroid Carcinoma,” Gland Surgery 6, no. 5 (2017): 594–597, 10.21037/gs.2017.07.12. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22. Kwon H., Kim H., Park S., et al., “Solitary Skin Metastasis of Papillary Thyroid Carcinoma,” Endocrinology and Metabolism 29, no. 4 (2014): 579–583, 10.3803/EnM.2014.29.4.579. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23. Ito Y., Tomoda C., Uruno T., et al., “Needle Tract Implantation of Papillary Thyroid Carcinoma After Fine‐Needle Aspiration Biopsy,” World Journal of Surgery 29, no. 12 (2005): 1544–1549, 10.1007/s00268-005-0086-x. [DOI] [PubMed] [Google Scholar]
  • 24. Filetti S., Durante C., Hartl D., et al., “Thyroid Cancer: ESMO Clinical Practice Guidelines for Diagnosis, Treatment and Follow‐up,” Annals of Oncology 30, no. 12 (2019): 1856–1883, 10.1093/annonc/mdz400. [DOI] [PubMed] [Google Scholar]
  • 25. Haugen B. R., Alexander E. K., Bible K. C., et al., “2015 American Thyroid Association Management Guidelines for Adult Patients With Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer,” Thyroid 26, no. 1 (2016): 1–133, 10.1089/thy.2015.0020. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26. Pujol P., Daures J. P., Nsakala N., Baldet L., Bringer J., and Jaffiol C., “Degree of Thyrotropin Suppression as a Prognostic Determinant in Differentiated Thyroid Cancer,” Journal of Clinical Endocrinology & Metabolism 81, no. 12 (1996): 4318–4323, 10.1210/jcem.81.12.8954034. [DOI] [PubMed] [Google Scholar]
  • 27. McGriff N. J., Csako G., Gourgiotis L., Guthrie L. C., Pucino F., and Sarlis N. J., “Effects of Thyroid Hormone Suppression Therapy on Adverse Clinical Outcomes in Thyroid Cancer,” Annals of Medicine 34, no. 7–8 (2002): 554–564, 10.1080/078538902321117760. [DOI] [PubMed] [Google Scholar]
  • 28. Erickson L. A., Jin L., Nakamura N., Bridges A. G., Markovic S. N., and Lloyd R. V., “Clinicopathologic Features and BRAF(V600E) Mutation Analysis in Cutaneous Metastases From Well‐Differentiated Thyroid Carcinomas,” Cancer 109, no. 10 (2007): 1965–1971, 10.1002/cncr.22641. [DOI] [PubMed] [Google Scholar]
  • 29. Xing M., Westra W. H., Tufano R. P., et al., “BRAF Mutation Predicts a Poorer Clinical Prognosis for Papillary Thyroid Cancer,” Journal of Clinical Endocrinology & Metabolism 90, no. 12 (2005): 6373–6379, 10.1210/jc.2005-0987. [DOI] [PubMed] [Google Scholar]
  • 30. Jin A., Xu J., and Wang Y., “The Role of TERT Promoter Mutations in Postoperative and Preoperative Diagnosis and Prognosis in Thyroid Cancer,” Medicine 97, no. 29 (2018): e11548, 10.1097/MD.0000000000011548. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31. Liu R. and Xing M., “TERT Promoter Mutations in Thyroid Cancer,” Endocrine‐related Cancer 23, no. 3 (2016): R143–R155, 10.1530/ERC-15-0533. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32. Monti E., Dono M., Gonella E., et al., “An H‐TERT Mutated Skin Metastasis as First Occurrence in a Case of Follicular Thyroid Carcinoma,” Frontiers in Endocrinology 10 (2019): 513, 10.3389/fendo.2019.00513. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33. Frost N., Zhamurashvili T., von Laffert M., et al., “Pemetrexed‐Based Chemotherapy Is Inferior to Pemetrexed‐Free Regimens in Thyroid Transcription Factor 1 (TTF‐1)‐Negative, EGFR/ALK‐Negative Lung Adenocarcinoma: A Propensity Score Matched Pairs Analysis,” Clinical Lung Cancer 21, no. 6 (2020): e607–e621, 10.1016/j.cllc.2020.05.014. [DOI] [PubMed] [Google Scholar]
  • 34. Shi L. P., Wang C. B., Cheng Y. Z., et al., “Relationship Between the Expression Levels of TTF‐1 and Galectin‐3 in Differentiated Thyroid Carcinoma Tissues and Clinical Manifestations and Prognosis of Patients,” International Journal of Laboratory Medicine 45, no. 4 (2024): 457–461. [Google Scholar]
  • 35. Lin J. D., “Thyroglobulin and Human Thyroid Cancer,” Clinica Chimica Acta 388, no. 1–2 (2008): 15–21, 10.1016/j.cca.2007.11.002. [DOI] [PubMed] [Google Scholar]
  • 36. Doutre M. S., Beylot C., Baquey A., et al., “Cutaneous Metastasis From Papillary Carcinoma of the Thyroid,” Dermatologica 177, no. 4 (2009): 241–243, 10.1159/000248571. [DOI] [PubMed] [Google Scholar]
  • 37. Lissak B., Vannetzel J. M., Gallouedec N., Berrod J. L., and Rieu M., “Solitary Skin Metastasis as the Presenting Feature of Differentiated Thyroid Microcarcinoma: Report of Two Cases,” Journal of Endocrinological Investigation 18, no. 10 (1995): 813–816, 10.1007/BF03349817. [DOI] [PubMed] [Google Scholar]
  • 38. Khan O. A., Roses D. F., and Peck V., “Papillary Thyroid Carcinoma Metastatic to Skin May Herald Aggressive Disease,” Endocrine Practice 16, no. 3 (2010): 446–448, 10.4158/EP09178.CR. [DOI] [PubMed] [Google Scholar]
  • 39. Arat Y. O. and Boniuk M., “Red Lesions of the Iris, Choroid, and Skin Secondary to Metastatic Carcinoma of the Thyroid: A Review,” Survey of Ophthalmology 52, no. 5 (2007): 523–528, 10.1016/j.survophthal.2007.06.006. [DOI] [PubMed] [Google Scholar]
  • 40. Li X. O., Li Z. P., Wang P., et al., “Pancreatic Metastasis of Papillary Thyroid Carcinoma: A Case Report With Review of the Literature,” International Journal of Clinical and Experimental Pathology 7, no. 2 (2014): 819–822. [PMC free article] [PubMed] [Google Scholar]
  • 41. Borschitz T., Eichhorn W., Fottner C., et al., “Diagnosis and Treatment of Pancreatic Metastases of a Papillary Thyroid Carcinoma,” Thyroid 20, no. 1 (2010): 93–98, 10.1089/thy.2009.0026. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 42. Siddiqui A. A., Olansky L., Sawh R. N., and Tierney W. M., “Pancreatic Metastasis of Tall Cell Variant of Papillary Thyroid Carcinoma: Diagnosis by Endoscopic Ultrasound‐Guided Fine Needle Aspiration,” JOP: Journal of the Pancreas 7, no. 4 (2006): 417–422. [PubMed] [Google Scholar]
  • 43. Tunio M. A., Alasiri M., Riaz K., and Alshakweer W., “Pancreas as Delayed Site of Metastasis From Papillary Thyroid Carcinoma,” Case Reports in Gastrointestinal Medicine 2013 (2013): 386263, 10.1155/2013/386263. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 44. Ronga G., Colandrea M., Montesano T., et al., “Solitary Skin Metastasis From Papillary Thyroid Carcinoma,” Thyroid 17, no. 5 (2007): 477–478, 10.1089/thy.2006.0162. [DOI] [PubMed] [Google Scholar]
  • 45. Ito Y., Onoda N., and Okamoto T., “The Revised Clinical Practice Guidelines on the Management of Thyroid Tumors by the Japan Associations of Endocrine Surgeons: Core Questions and Recommendations for Treatments of Thyroid Cancer,” Endocrine Journal 67, no. 7 (2020): 669–717, 10.1507/endocrj.EJ20-0025. [DOI] [PubMed] [Google Scholar]
  • 46. Filetti S., Durante C., Hartl D. M., et al., “ESMO Clinical Practice Guideline Update on the Use of Systemic Therapy in Advanced Thyroid Cancer,” Annals of Oncology 33, no. 7 (2022): 674–684, 10.1016/j.annonc.2022.04.009. [DOI] [PubMed] [Google Scholar]
  • 47. Haddad R. I., Bischoff L., Applewhite M., et al., “NCCN Guidelines® Insights: Thyroid Carcinoma, Version 1.2025,” Journal of the National Comprehensive Cancer Network 23, no. 7 (2025): e250033, 10.6004/jnccn.2025.0033. [DOI] [PubMed] [Google Scholar]
  • 48. Chu H., Wang D., and Qu Y., “Skin Metastasis of Papillary Thyroid Carcinoma: A Case Report and Literature Review,” Oncology Letters 29, no. 1 (2024): 43, 10.3892/ol.2024.14789. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 49. Polyzos S. A. and Anastasilakis A. D., “A Systematic Review of Cases Reporting Needle Tract Seeding Following Thyroid Fine Needle Biopsy,” World Journal of Surgery 34, no. 4 (2010): 844–851, 10.1007/s00268-009-0362-2. [DOI] [PubMed] [Google Scholar]
  • 50. Liu Z., Liu X., Xu Q., and Lin C., “Papillary Thyroid Carcinoma With Shoulder Skin Metastasis: A Case Report and Literature Review,” Asian Journal of Surgery 45, no. 10 (2022): 1966–1967, 10.1016/j.asjsur.2022.04.037. [DOI] [PubMed] [Google Scholar]
  • 51. Aghasi M., Valizadeh N., and Soltani S., “A 64 Year‐Old Female With Scalp Metastasis of Papillary Thyroid Cancer,” Indian Journal of Endocrinology and Metabolism 15, no. Suppl 2 (2011): 136, 10.4103/2230-8210.83353. [DOI] [PMC free article] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The authors have nothing to report.

Articles from World Journal of Otorhinolaryngology - Head and Neck Surgery are provided here courtesy of Chinese Medical Association

RESOURCES