Ray Resection for Recurrent Invasive Squamous Cell Carcinoma: A Case Report

Abstract

Squamous cell carcinoma is the most common tumor of the hand. This malignancy requires unique treatment considerations; the surgeon and patient must balance retention of maximal functional capacity of the hand and minimization of the risk of recurrence and metastasis. Digital-sparing and digital-sacrificing therapies should be considered. Chance for cure, recurrence and metastasis risk, cosmetic concerns, and functional concerns should be addressed on a case-by-case basis. We report a case of a fifty-three-year-old man with cutaneous squamous cell carcinoma of his non-dominant hand. Ulceration and rapid growth of a long-standing lesion of the dorsal hand prompted evaluation and treatment. Over the course of a year, three separate surgeries including digital amputations and metacarpal resections were required to manage this recurrent and invasive malignancy. Seven years post-operatively, our patient retained a full, painless range of motion arc of the left thumb and ability to grip utilizing a functional brace. Treatment of squamous cell carcinoma of the hand is not always straightforward. High rates of local recurrence require negative margins and diligent postoperative surveillance. Digital sparing therapy should be considered to minimize functional impairment and maximize cosmesis. However, aggressive treatment and amputation must be considered for advanced disease and if pursued, should focus on maximization of functional capacity as one of the treatment goals.

Keywords: finger amputation; hand surgery; orthopaedic oncology; ray resection; squamous cell carcinoma.

Figure 1:. PA radiograph of left hand revealing the radiopaque lesion on the ulnar aspect of the third digit, centered at the PIP joint.

Figure 2:. Lateral radiograph of the left hand revealing the radiopaque lesion on the dorsal aspect of the third digit, centered at the PIP joint.

Figure 3:. PA radiograph of the left hand after the second surgery but prior to the third surgery, demonstrating partial amputation of the third and fourth metacarpals.

Figure 4:. Clinical photograph of the left hand status-post metacarpal 2-5 partial resections. Well-healed surgical incision.

Figure 5:. Clinical photograph of the left hand status-post metacarpal 2-5 partial resections. Thumb is completely preserved with a full, painless range of motion.

Figure 6:. Clinical photograph demonstrating a well-fitted functional brace that allows for gripping between the thumb and brace.