Mohs Micrographic Surgery for the Treatment of Cutaneous Metastases in a Patient With Papillary Thyroid Carcinoma

Aria, Alexander B.; Chen, Leon; Rosenbaum, Lara E.; Migden, Michael R.

doi:10.1097/dss.0000000000001459

Cited by 2 publications

(3 citation statements)

References 5 publications

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“…Our present patient is certainly unusual in having 3 SM in the context of stage I node-positive disease, developing his first SM at 13 years after presentation, and in 16 postoperative years to have at present no evidence of extracervical spread of his disease. We are familiar with a recent report [ 36 ] of the successful use of Mohs micrographic surgery in treating 2 SM involving the scalp in an 82 year old man with widely disseminated PTC. However, we believe that our patient is unique in having not only successful Mohs surgery, but 2 other successful excisions of SM performed in the setting of LRPTC localized to the neck.…”

Section: Discussionmentioning

confidence: 99%

Elimination of Locoregional Recurrences and Skin Metastases in Papillary Thyroid Cancer by Ethanol Ablation and Mohs Surgery

Iñiguez-Ariza

Lee

Brewer

et al. 2020

Journal of the Endocrine Society

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Abstract Ultrasound-guided percutaneous ethanol ablation procedures for locoregional recurrences in papillary thyroid carcinoma (PTC) can be repeatedly performed over years. Skin metastases (SM) from PTC generally portend a lethal prognosis. Our patient demonstrates the innovative use in low-risk PTC (LRPTC) of treatment modalities designed to prevent neck re-explorations and capable of eliminating both locoregional recurrences and SM. In 2004, a 48-year-old man presented with neck nodal metastases due to PTC. He underwent a near-total thyroidectomy and nodal dissection, confirming an 8-mm PTC involving two ipsilateral node metastases. Postoperatively, he received two doses of RAI for remnant uptake (cumulative dose 338 mCi); post-therapy scanning was unrevealing. In 2007, he underwent right neck dissection for further node metastases. In 2008, a guided biopsy confirmed a level IV node metastasis. He was referred to our institution for ethanol ablation. Two node metastases were ablated and subsequently disappeared. During 2010-16, he developed a further six node metastases which were treated with ethanol ablation; all disappeared on high-resolution sonography. FDG-PET-CT scans in 2009 and 2016 were negative for distant spread. In 2016, a SM in right neck was removed by dermatologic surgery. In 2017-18 two further SM were excised with negative margins, one after Mohs surgery. He has now been disease-free for twenty months. In conclusion, despite three neck surgeries and two RAI therapies, our patient repeatedly developed both locoregional recurrences and SM. All eleven disease foci were eliminated with minimally invasive procedures which should more often be considered as effective treatment options in LRPTC.

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Section: Discussionmentioning

confidence: 99%

Elimination of Locoregional Recurrences and Skin Metastases in Papillary Thyroid Cancer by Ethanol Ablation and Mohs Surgery

Iñiguez-Ariza

Lee

Brewer

et al. 2020

Journal of the Endocrine Society

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“…The diagnosis is difficult to establish unless an index of suspicion is positive (17,18,19). Reports of skin metastases include subjects with follicular and papillary subtypes and also papillary with follicular variant or anaplastic forms among follicular epithelium derived malignancies (11,12,20,21).…”

Section: Skin Metastasesmentioning

confidence: 99%

“…Also, the use of immunohistochemistry marker PAX-8 applies for spindle cell component of anaplastic thyroid cancer/skin metastases as a differential diagnosis tool from others malignancies containing spindle cells (21). If isolated or radioiodine refractory, surgical removal of cutaneous metastasis is indicated (18).…”

Section: Skin Metastasesmentioning

confidence: 99%

Skin metastasis as incidental finding in follicular epithelium derived – thyroid cancer

Şandru¹,

Valea²,

Albu³

et al. 2020

Ro J Med Pract.

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Skin metastases are not typical. Malignancies like mammary cancer (most frequent in females) and pulmonary neoplasia (most frequent in males) represent the majority and exceptional findings are in those originating from thyroid, prostate, ovaries and oesophagus, usually in advanced, generally disseminated stages, with a poor prognosis. It may be found more often in elderly patients. We aim to present some practical aspects of skin metastases in thyroid cancer that originates from follicular thyroid epithelium. This is a brief literature review. The level of evidence is poor since most data is provided from cases reports. Cutaneous malignant lumps are rarely the first sign of disease, mostly associating a cancer relapse. The location varies from neck and head (majority) to exceptional sites as chest wall and of variable rate for scalp. Underling neck muscle or Meckel's cave metastasis may be associated. The lesion is usually a lump of medium to small size, sometimes of papular appearance, without local pain (but depends on the site); it may associate erythema. The diagnosis is difficult unless an index of suspicion is positive (in which case whole body radioiodine scintigram may be useful). Biopsy and histological report are essential for diagnosis especially in cases without an evident connection to a prior/synchronous thyroid malignancy. Knowing the exceptional prevalence, the need for awareness in this particular topic is connected with a multidisciplinary daily practice.

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Mohs Micrographic Surgery for the Treatment of Cutaneous Metastases in a Patient With Papillary Thyroid Carcinoma

Cited by 2 publications

References 5 publications

Elimination of Locoregional Recurrences and Skin Metastases in Papillary Thyroid Cancer by Ethanol Ablation and Mohs Surgery

Elimination of Locoregional Recurrences and Skin Metastases in Papillary Thyroid Cancer by Ethanol Ablation and Mohs Surgery

Skin metastasis as incidental finding in follicular epithelium derived – thyroid cancer

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