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Concurrent metastases of papillary thyroid carcinoma to the scalp and Meckel’s cave
  1. Patrick S Phelan1,
  2. Jamie L Mull2,
  3. Mohamed Z Rajput3,
  4. Amy C Musiek2
  1. 1Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
  2. 2Division of Dermatology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
  3. 3Washington University in Saint Louis School of Medicine, Mallinckrodt Institute of Radiology, Saint Louis, Missouri, USA
  1. Correspondence to Dr Jamie L Mull, jamie.l.mull{at}


We present the case of a 65-year-old man with severe headaches and unilateral facial weakness, seen in consultation by the dermatology service to rule out primary cutaneous melanoma after brain imaging identified an enlarging mass within the right trigeminal (Meckel’s) cave. Examination revealed only a pair of erythematous papules on the scalp, for which biopsy demonstrated metastatic papillary thyroid carcinoma. Further evaluation and subsequent thyroidectomy confirmed the origin of widespread internal disease, followed by definitive excision of scalp lesions and multimodal management of systemic involvement. Whereas presentation of metastasis to the skin is highly variable, a low threshold for biopsy may allow for histological identification of internal disease not otherwise considered in the clinical differential.

  • dermatology
  • endocrine cancer

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  • Contributors JLM and ACM conceived of the present report. JLM, MZR and ACM provided patient care and supplied clinical information to PSP, with report planning carried out among all authors. MZR prepared and interpreted imaging studies for illustration. PSP performed review of the literature and drafted the initial manuscript, with primary editing and revision by JLM and PSP. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.