Scalp Metastasis from Thyroid Carcinoma 12 Years Post-thyroidectomy: Clinical and Ethical Lessons
M. O. Udoh *
Department of Pathology, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria.
D. F. Mekoma
Department of Pathology, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria.
C. Osime
Department of Surgery, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria.
U. O. Igbokwe
Department of Cellular Pathology, Queens Hospital, Romford, Essex, United Kingdom.
*Author to whom correspondence should be addressed.
Abstract
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.
Keywords: Thyroid carcinoma, scalp metastasis, recurrence, medical records.