Although the majority of differentiated thyroid cancers show an indolent course, about 15% of the cancers invade via extra-thyroidal extension (ETE). ETE usually occurs through direct spreading to the strap muscles, the sternocleidomastoid muscle, the recurrent laryngeal nerve, the trachea, the larynx, the esophagus, the pharynx, and/or the major vessels. Direct invasion to the subcutaneous tissue and overlying skin is possible but a rare scenario. We report a 66-year-old patient with locally aggressive papillary thyroid cancer accompanied by skin necrosis. The tumor was resected completely without removal of the overlying skin.