Bilateral Thumb Metastasis From Breast Carcinoma

Metastatic Tumors to the Nail Unit: Subungual Metastases

“… a The patients were described to have serous drainage from the superficial ulcerations of the fungating lesions, 51 bleeding from an ulcerated bluish, nonpulsatile mass, 35 and profuse bleeding of a swollen, hot pulsating bluish‐red swelling. …”

“…In 6% (3 individuals) of patients with subungual metastases, the subungual tumor lesions involved not only their fingers, but also the left fifth toe, 35 multiple toes, 58 or the left great toe (and both thumbs) 70 . Symmetrical subungual metastases that involved either the same thumb, finger, or multiple digits of the hands have been described in six patients (Table 7) 12,18,51,59,63,70 . Metastatic subungual tumor restricted solely to either the right great toe (3 patients) 16,38,52 or the left great toe (1 patient) 16 was only reported in 8% (4 individuals) of patients with subungual metastases.…”

Metastatic Tumors to the Nail Unit: Subungual Metastases

“…Subungual metastases typically present as painful lesions of the distal digit. [1][2][3][6][7][8]12,13,15,16,31,[35][36][37]52,58,63,71 Less frequent presenting symptoms of subungual metastases include lesions that are either bleeding, 32,35,51 perceived as hot (when evaluated by the clinician), 3,32 fluctuant, 2,15,19,37 and/or pulsatile. 12,32 The most common appearance of the lesion is either as an erythematous enlargement or swelling of the distal digit or a red to violacious nodule that distorts either the nail plate, or the soft tissue of the distal digit, or both ( Table 3).…”

“…12,136 Prior studies have evaluated the relationship between the site of origin of the primary tumor and the incidence of metastases to either the distal upper extremity or the distal lower extremity. Lung cancer was the most common malignancy in patients with meta- 51 bleeding from an ulcerated bluish, nonpulsatile mass, 35 and profuse bleeding of a swollen, hot pulsating bluish-red swelling. b Clinically the lesions were considered to simulate a necrotizing vasculitis.…”

“…70 Symmetrical subungual metastases that involved either the same thumb, finger, or multiple digits of the hands have been described in six patients (Table 7). 12,18,51,59,63,70 Metastatic subungual tumor restricted solely to either the right great toe (3 patients) 16,38,52 or the left great toe (1 patient) 16 was only reported in 8% (4 individuals) of patients with subungual metastases.…”