[Squamous cell carcinoma of the palm: a case report]

Abstract

Squamous cell carcinoma (SCC) arising from the palm skin is very rare, having a very aggressive course and poor outcome. A 74-year-old male patient presented with a painful and rapidly growing nodular lesion, 20 mm in size, in the distal part of the right palm. He received antibiotic treatment at another center with the thought of an infection, and then with oral corticosteroids with an estimation of a granuloma. The patient underwent a wide excision with an initial diagnosis of skin cancer, followed by full-thickness skin grafting. Histopathologic examination showed moderately differentiated SCC extending to the deep subcutaneous tissue and positivity in deep surgical margins. Subsequent surgery included ray amputation involving index and middle fingers. However, recurrent skin lesions appeared in the dorsum of the hand together with enlarged lymph nodes in the epitrochlear and medial axillary regions. Following a wide surgical removal of the lesions, metastases were detected in epitrochlear and axillary lymph nodes and in fatty subcutaneous tissue. A month later, new lesions developed in the dorsum of the hand, which required another surgical excision. However, new epitrochlear lymph nodes and multifocal lesions in the right axillary region emerged. This time, radical radiotherapy was administered. In a short time, cutaneous and subcutaneous metastases in the thoracic wall and widespread lung metastases were detected. The patient died from pulmonary complications 10 months after presentation.