Skin Cancers of the Hand and Upper Extremity

doi:10.1016/j.jhsa.2011.10.042

The Journal of Hand Surgery

Volume 37, Issue 1, January 2012, Pages 171-178

https://doi.org/10.1016/j.jhsa.2011.10.042 Get rights and content

Skin cancers represent the most common primary malignancies of the hand. They typically present as painless lesions on areas of high sun exposure, such as the dorsum of the hand and upper extremity. The most common malignancy is squamous cell carcinoma, followed by basal cell carcinoma and melanoma. The key to successful treatment is early and accurate diagnosis and treatment. Unlike open biopsies, which are indicated for deep soft tissue and bone lesions, biopsies for skin cancer can be performed under local anesthesia in the office setting in the form of shave or punch biopsies. A number of nonsurgical treatment options are available for treatment. However, when surgical excision is indicated, appropriate margin resections are dictated by the grade and stage of the malignancy.

Section snippets

Diagnosis

The initial step in diagnostic evaluation of a potential skin cancer of the upper extremity should be a biopsy. Unlike open biopsies for deep soft tissue and bone lesions, biopsies for skin cancer can be performed under local anesthesia in the office setting. Often, shave biopsies are sufficient; however, a punch biopsy should be considered for indurated, atrophic, and/or pigmented lesions.

A shave biopsy can be performed by infiltrating the lesion locally with lidocaine, with or without

Squamous Cell Carcinoma

Squamous cell carcinoma makes up approximately 20% of all skin cancers; it is often located in areas of intense ultraviolet light or sun exposure. There are approximately 200,000 new cases of SCC each year. Risk factors include fair skin, cumulative over-exposure to ultraviolet radiation, advancing age, outdoor vocation, and sunnier geographic locations. The hand and upper extremity are at risk for SCC development; however, SCC is most often found on the head and neck.⁵ Other causes that place

Basal Cell Carcinoma

Basal cell carcinoma (BCC) makes up about 80% of all skin cancers, making it the most common type of cancer and the most common type of skin cancer. Ultraviolet exposure is thought to be the most common cause. Despite this, the hand and upper extremity are not the most common locations for these lesions, as they make up only about 10% of BCCs. The most common locations for BCCs are the head and trunk, making up over 75% of these lesions.³⁷ Basal cell carcinomas tend to occur after the fourth

Melanoma

Melanoma is an aggressive, cutaneous malignancy for which early detection and intervention are essential for prognosis and survival. The incidence of melanoma is rising at a faster rate than that of any other cancer, and it is now the most common form of cancer for young adults aged 25 to 29 and the second most common form of cancer for young people 15 to 29 years old.⁵³ However, most melanomas are diagnosed in white males over the age of 50.⁵⁴ There are 4 major types of melanoma, based on

Merkel Cell Carcinoma

Merkel cell carcinoma (MCC) is extremely uncommon; however, when it does arise, it occurs in sun-exposed areas. Due to the limited number of reported cases, it is difficult to state the proportion arising on the upper extremity; however, one recently published review⁶⁵ cited that about 20% arise on the upper extremities, and another recently published review⁶⁶ of 875 cases cited about 40% arising on the extremities, with a mean age of 68 years. The mortality associated with MCC was found in

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“Basal cell carcinoma of the hand: A systematic review and meta-analysis of incidence of recurrence”
2023, JPRAS Open
Citation Excerpt :
On the other hand, acral BCC presents as erythematous skin plaques with scaling or exophytic tumors with the absence of the classical pearly appearance and telangiectasia. The diagnosis of a suspected BCC is made through either a shave biopsy or a punch biopsy.9 There are several histological types of BCC, including superficial and nodular, and types with high recurrence rates, such as micronodular, infiltrative, metatypical, and morpheaform patterns.10
Hand basal cell carcinoma is a rare and complex disorder. Due to the hand's anatomical features, managing hand BCC is challenging. Therefore, we have conducted this systematic review to investigate various clinical characteristics, investigations, and treatment options related to hand BCC. Furthermore, a meta-analysis was used to provide pooled recurrence rates.
We conducted this review per the International Prospective Register of Systematic Reviews (PROSPERO) guidelines. This study performed a systematic literature review in February 2022 using the following electronic databases: Cochrane, MEDLINE, and EMBASE. Key terms include hand basal cell carcinoma, basal cell carcinoma, management, outcome, and recurrence. We evaluated articles according to predefined quality criteria.
The study included 9725 patients and 51 published articles. A total of 35 case reports, 2 case series, 1 prospective study, and the remaining retrospective studies were evaluated. An asymptomatic skin lesion was the main complaint. In 10 studies, Moh surgery was the most frequently used treatment method. In the seven studies included in the meta-analysis, the overall incidence rate of recurrence among the included patients was 1.49 cases per year.
The optimal extent of surgical treatment is still controversial, though an early biopsy can help identify lesions at an early stage. It is the first study to provide occurrence rates based on a meta-analysis. Developing treatment guidelines for BCC of the hand will be the focus of future research.
Grafting and Other Reconstructive Options for Nail Deformities: Indications, Techniques, and Outcomes
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Citation Excerpt :
Solid malignancies including basal cell carcinoma, squamous cell carcinoma, and melanoma are rare. Basal cell carcinoma should be resected to negative margins and has an excellent 5-year cure rate.64 Squamous cell represents the most common primary malignancy of the subungual space and wide local excision is recommended.65,66
Subungual Melanoma
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Numerous case reports show a delay in diagnosis resulting in higher mortality (Fig. 5). Ilyas and colleagues17 recommend regular dermatology follow-up for any patient with a subungual melanoma. Mannava and colleagues5 recommend referral to medical oncology and advanced imaging in the form of computed tomography (CT) and/or MRI of brain, chest, abdomen, and pelvis versus a whole-body PET-CT in any stage III or IV melanoma (metastatic melanoma).
Subungual Tumors: An Algorithmic Approach
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The presentation of benign and malignant subungual tumors often follows a final common pathway of nonspecific nail deformity; as such, delays in diagnosis are common. Therefore, it is imperative to have a high degree of suspicion for malignant lesions and an organized approach to subungual tumors. To that end, we present a diagnostic algorithm encompassing the most common benign and malignant subungual tumors, along with a summary of the presentation, imaging, and treatment of these lesions.
A single centre experience of squamous cell carcinoma of the upper limb requiring digital or hand amputation and review of literature
2019, JPRAS Open
Citation Excerpt :
Non-melanoma skin cancer (NMSC) accounts for approximately 90% of all skin cancers registered in the UK and Ireland with squamous cell carcinoma (SCC) representing around 23% of these1. Furthermore, it is the most common primary malignant tumour of the hand2 and studies of full body anatomical distribution report it to be present on the upper limb in 9-35% of cases3–5. When comparing relative tumour densities of other NMSCs such as basal cell carcinoma (BCC), the most notable difference was the prevalence in the hand with a BCC:SCC ratio of 1:14.5
Squamous cell carcinoma (SCC) is one of the most common primary malignancies affecting the upper limb. A range of treatment options exist for its management; amputation being indicated under certain instances. This is the first comprehensive case series and review of the literature reporting outcomes following amputation of the affected region for treatment of upper extremity SCC. We present a series of six patients with squamous cell carcinoma of the upper limb that required amputation alongside that of data from literature review. Patient demographics, risk factors, tumour characteristics and rates of recurrence, metastasis and mortality were recorded. A total of 45 patients with 49 histologically confirmed squamous cell carcinomas were identified from case series and literature review. Patients presenting with upper limb SCC were predominantly male and in their sixth decade of life. Mean follow up time was 30.5 months and the overall recurrence and metastatic rates were 8.2% and 14.3%, respectively. Mortality was 14.3% however only 6.1% was related to SCC metastasis. Rates of recurrence and metastasis are higher for SCCs affecting the hand as compared to other body sites. Furthermore, different regions of the hand appear to behave differently. SCC affecting the nail unit has a high recurrence and a low metastatic rate, whereas, SCC involving the palm and webspaces are aggressive and this is true despite amputation of the affected site.

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Current conceptSkin Cancers of the Hand and Upper Extremity

Section snippets

Diagnosis

Squamous Cell Carcinoma

Basal Cell Carcinoma

Melanoma

Merkel Cell Carcinoma

J Am Acad Dermatol

J Am Acad Dermatol

J Am Acad Dermatol

J Am Acad Dermatol

J Am Acad Dermatol

J Am Acad Dermatol

J Am Acad Dermatol

J Am Acad Dermatol

J Am Acad Dermatol

J Am Acad Dermatol

Ann Dermatol Venereol

J Am Acad Dermatol

Br J Plast Surg

J Am Acad Dermatol

J Hand Surg

J Am Acad Dermatol

J Am Acad Dermatol

J Am Acad Dermatol

J Am Acad Dermatol

J Am Acad Dermatol

J Am Acad Dermatol

Lancet

J Am Acad Dermatol

Modern Pathology

J Am Acad Dermatol

J Am Acad Dermatol

J Am Acad Dermatol

J Am Acad of Dermatol

J Am Acad Dermatol

J Am Acad Dermatol

J Am Acad Dermatol

J Am Acad Dermatol

J Am Acad Dermatol

Current concept
Skin Cancers of the Hand and Upper Extremity