Skin Cancers of the Hand and Upper Extremity

Ilyas, Erum; Leinberry, Charles F.; Ilyas, Asif M.

doi:10.1016/j.jhsa.2011.10.042

Cited by 28 publications

(42 citation statements)

References 61 publications

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“…It has been reported that malignant melanoma occurs in the fingertip in up to 29% of patients with melanoma in the hand, a notably high incidence compared with other kinds of skin cancer of the hand. 17,18 In these cases, the size of soft tissue defect after excision of skin cancer is relatively small, and reconstruction involves various important factors, including function and esthetics, because the fingernail complex exhibits important and unique functions, such as tactile sense, pinching, and bone protection.…”

Section: Discussionmentioning

confidence: 99%

“…19Y21 Recently, numerous reports have demonstrated the validity of conservative surgery in noninvasive or low-grade skin cancer of the hand. 18,22 Overall, the strategy has changed from radical surgery, including ray amputation, to a more conservative treatment. 1,23, 24 Moehrle et al 1 reported that, in comparison with amputation surgery, functional surgery of subungual melanoma did not negatively affect the recurrence and the prognosis of patients and ensured a tumor-free margin.…”

Section: Discussionmentioning

confidence: 99%

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Venous Free Flaps for the Treatment of Skin Cancers of the Digits

Park¹,

Kim²,

Kwon³

2015

Annals of Plastic Surgery

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Microvascular reconstruction using distant free flaps is often required after excision of skin cancers of the digits. The delivered flaps should be chosen with many factors taken into consideration, especially in the digits, in which a very thin, pliable, and durable flap is required to maintain both function and cosmetic appearance. Free flaps, such as perforator flaps, however, for distal or small defects of the hand after excision of skin cancer, require the sacrifices of the main arterial pedicle with deep dissection and exhibit potential limitations regarding flap size and location of the defect. Instead, arterialized venous free flap could be used as an alternative reconstructive method for skin cancers of the digits. Twelve soft tissue defects of the digits after excision of skin cancers (5 cases of malignant melanoma and 7 cases of squamous cell carcinoma) were reconstructed using arterialized venous free flaps from January 2009 to May 2011. The flaps ranged in size from 1 × 1.5 cm to 5 × 7 cm. The flaps completely survived in 9 cases. Partial necrosis developed in 3 cases; however, skin graft was necessary only for 1 case. There were no recurrences or metastases for at least 20 months after the last case. Recently in cases of noninvasive or low-grade skin cancer of the hand, the concept of "preservative surgery" has been a higher priority compared with functional and esthetic aspects. Particularly in cases of reconstruction of a small-sized fingertip defect as 1 functional unit, arterialized venous free flaps offer several advantages, such as thinness and color similar to the hand, technical ease with a short operative time, long vascular pedicle, less donor site morbidity with no sacrifice of a major vessel, applicable to any site, and modifiable to the appropriate size and shape. Arterialized venous free flap could serve as a useful and reliable method for soft tissue reconstruction after excision of skin cancers in the digits.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Venous Free Flaps for the Treatment of Skin Cancers of the Digits

Park¹,

Kim²,

Kwon³

2015

Annals of Plastic Surgery

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“…For standard WLE, the recommended excision margin for high-risk SCC is at least 6 mm, and for low-risk SCC, a margin of at least 4 mm. Although the neoplasm is limited to the skin, the excision should be taken down to the subcutaneous fat12 or to a depth one layer below the tumour along with any adjacent area of induration 13. The literature includes diverse studies reviewing the treatment of SCC of the head and neck, but there are few studies focusing on the outcomes of surgical excision of SCC of the hand.…”

Section: Discussionmentioning

confidence: 99%

Moderately differentiated squamous cell carcinoma of the palm: an extremely infrequent tumour

et al. 2014

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SUMMARYSquamous cell carcinoma of the palm is a very infrequent malignancy. Its unusual presentation can produce a delay in the final diagnosis with serious consequences as far as morbidity and mortality are concerned. This article summarises the case of a patient who was referred to our department presenting a squamous cell carcinoma on his left palm and a clinically positive axillar lymphadenopathy. He had previously been wrongly diagnosed on several occasions. BACKGROUND

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“…Training and previous clinical experience are shown to improve the index of suspicion and the rate of accurate diagnosis 10. Overall, if one is suspected, prompt excisional biopsy with safe margins should be done to provide accurate diagnosis, depth and staging 3. According to clinical guidelines produced by the British association of Dermatologists, patients with suspected lesions should be referred urgently to a dermatologist or surgeon with a declared interest in this field of cancer surgery, in line with the 2-week referral standard 11…”

Section: Discussionmentioning

confidence: 99%

If it is not healing, do worry about it!

2013

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We present the case of a 44-year-old patient who crushed her ring finger in a door 4 months earlier. She was treated in the community for her chronic fingertip wound/pyogenic granuloma. As the lesion was not healing with regular wound management she was eventually referred to secondary care for an opinion. She underwent immediate excisional biopsy with safe margins for tissue diagnosis and had histological confirmation of an advanced malignant melanoma. The staging head, neck, thorax, abdomen and pelvic CT showed lymph node enlargement and widespread metastatic lesions. Our case shows how if hand lesions are not resolved following trauma, the patient needs to be assessed for unusual pathologies and, if necessary, or in doubt, referred to the specialists.

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Skin Cancers of the Hand and Upper Extremity

Cited by 28 publications

References 61 publications

Venous Free Flaps for the Treatment of Skin Cancers of the Digits

Venous Free Flaps for the Treatment of Skin Cancers of the Digits

Moderately differentiated squamous cell carcinoma of the palm: an extremely infrequent tumour

If it is not healing, do worry about it!

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