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Choroidal and Skin Metastases from Papillary Thyroid Cancer: Case and a Review of the Literature

Division of Nuclear Medicine, Department of Radiology (A.M.A., J.C.S.), Division of Dermatology (R.G., L.S.), and Department of Ophthalmology and Visual Sciences (A.K.V.), Kellogg Eye Center, University of Michigan Medical Center, Ann Arbor, Michigan 48109

Address all correspondence and requests for reprints to: Dr. James C. Sisson, University of Michigan Medical Center, 1500 East Medical Center Drive, UH B1G 505D, Ann Arbor, Michigan 48109-0028. E-mail: jsisson{at}med.umich.edu.

A patient with widely metastatic papillary thyroid cancer who had been previously treated with ¹³¹I and external beam radiation presented with purple nodular lesions on his face and scalp. On biopsy, the nodules were papillary carcinoma with cells that stained for thyroglobulin. Subsequently he developed decreased left eye visual acuity, and fundoscopy revealed lesions typical of choroidal metastases. Dermal and choroidal metastases of papillary thyroid carcinoma are both rare. However, the significance of these clinical manifestations may be overlooked and ignored unless the diagnosis is considered. New skin nodules or visual acuity decline in a patient with papillary thyroid cancer may represent manifestations of distant metastatic disease and should prompt thorough evaluation with dermatological examination and fundoscopy. Choroidal and skin metastases have almost always occurred in patients with advanced disease, but initial presentation with these lesions is possible, and in such instances a thorough search for additional sites of metastatic disease is recommended. Occasionally such metastases may respond to ¹³¹I therapy or external beam radiation.