Cancer Metastases to the Hand: A Systematic Review and Meta-analysis

Abstract

Background: Metastatic lesions to the hand or wrist are rare and can mimic inflammatory and benign processes such as gout and infections. This often leads to misdiagnosis, underreporting, and delays in treatment. The purpose of this study was to examine all known cases of metastasis to the hand or wrist available in the literature and to analyze demographic trends, metastasis characteristics, and clinical course, and provide recommendations for management. Methods: An online systematic review of MEDLINE, Embase, PubMed, and the Cochrane Library from inception to January 7, 2022, was completed. Studies outlining the care of a patient with acrometastases of the hand were included. Data extracted included age, sex, site of primary tumor and metastasis, presence of other metastases, time from primary diagnosis to acrometastasis diagnosis, misdiagnosis, treatment, and survival. Results: Between 1889 and present, 871 lesions were described in 676 patients who met the inclusion criteria. There was no predilection for hand dominance or site of previous trauma. The mean age among patients was 59.5 (1.5-91) years, and male sex was more common (64.6%). The most common primary cancer source was the lung (39.2%), followed by the kidney (10.8%). The distal phalanx was the most frequently cited tumor location (33.7%). Mean survival after diagnosis of acrometastasis was 6.3 months (0.25-50) ± 11.5 months. Conclusion: Acrometastasis remains an uncommon presentation of metastatic disease with poor prognosis. Treatment currently focuses on pain management and optimizing functional outcomes. Our review led to the development of 7 treatment recommendations when managing these patients.

The rarest among the rare? Acrometastases and disability in the past and beyond

“…Diagnostic signs Metastatic lesions in the left hand and feet are the most relevant feature in this study. Acrometastases, which are exceedingly uncommon in modern clinical settings (Dow et al, 2023;Stomeo et al, 2015), account for only 0.1% of all MBD today, with metastases to the feet being even more exceptional (Dow et al, 2023;Stomeo et al, 2015;Umana et al, 2021). As reported in several studies, modern therapies and patient care have increased the survivability of cancer patients; thus, it likely that it also inherently increased the risk for acrometastases (Stomeo et al, 2015;Umana et al, 2021).…”

“…As reported in several studies, modern therapies and patient care have increased the survivability of cancer patients; thus, it likely that it also inherently increased the risk for acrometastases (Stomeo et al, 2015;Umana et al, 2021). Acrometastases tend to arise in advanced stages of neoplastic disease, generally associated with multiorgan involvement and with a reduced life expectancy ($6 months after their diagnosis) (Dow et al, 2023;Umana et al, 2021). Furthermore, acrometastases are the first sign of the disease in less than 10% of cancer patients (Umana et al, 2021).…”

“…It is plausible that it can be merely related with the direct observation of affected bones, contrary to the radiological exams in the clinical practice. If that is the case, it is therefore possible that the current clinical prevalence of acrometastases may be underestimated due to underreporting, inattention to the extremities in routine screening procedures, and medical imaging limitations (Stomeo et al, 2015;Dow et al, 2023). Yet, it is also conceivable that evolutionary and chemotherapy-related factors may have played a role and further research on this topic is advised.…”

“…A plethora of skeletal-related events associated with MBD are widely documented in the clinical literature, including severe pain, pathological fractures, spinal cord compression, renal function impairment, bone marrow aplasia, hypocalcemia, susceptibility to infections, generalized debility, or impaired mobility (Forsyth & Hofendoorn, 2021;Zacharia et al, 2021). Additionally, acrometastases often present swelling, tenderness, ulcerations, biomechanical malfunctions, and pathological fractures in the affected extremities (Dow et al, 2023).…”

“…Among the range of disease expressions of cancers in the past, evidence of rare disease manifestations can also be found both for primary and secondary cancers. For example, signs of acrometastases, which are metastatic bone lesions that are located distally to the elbow and knee, are exceedingly uncommon in modern epidemiology (Dow et al, 2023;Stomeo et al, 2015;Umana et al, 2021); however, these atypical manifestations can also be seen in past populations.…”