Journal of Clinical and Aesthetic Dermatology

AUG 2017

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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JCAD JouRnal oF CliniCal and aesthetiC deRMatology august 2017 • Volume 10 • number 8 42 42 C BaCkgRound: squamous cell carcinoma of t he palmar digits is rare. puRpose: the authors describe a man with squamous cell carcinoma of the pulp of his left fourth finger, and review the risk factors that may be associated with squamous cell carcinoma development on the ventral digits of the hand. the authors also summarize the clinical diserential diagnoses and treatment of squamous cell carcinoma at this location. Methods: the authors retrospectively reviewed the literature using Pubmed and searched for the following terms: squamous cell carcinoma, squamous cell carcinoma in situ, finger, thumb, palmar, and ventral. Papers were critically evaluated and their cited references reviewed. Results: skin biopsy established the patient's diagnosis. His tumor was excised using mohs technique with microscopic examination of the tissue margins; viral changes were noted in the keratinocytes. local or systemic carcinogen exposure, congenital conditions, suppressed host immunity, coincidental bacterial or viral infection, local radiation exposure, and trauma to the asected digit are risk factors associated with the development of palmar digit squamous cell carcinoma. the clinical diserential diagnoses of squamous cell carcinoma on the ventral digits include chronic dermatitis and keratoderma, epidermoid cyst, infection, melanoma, and verrucae. successful treatment involves removal of the tumor; this is usually accomplished by surgical excision of the tumor, which may include some or all of the asected digit. ConClusions: the diagnosis of squamous cell carcinoma of the ventral hand digits is often not initially suspected by the patient and/or the clinician. However, despite the occasional delay in diagnosis or subsequent large tumor size, the prognosis for these patients is usually favorable following adequate treatment of the cancer. key woRds: Carcinoma, cell, digit, distal, finger, pad, palmar, squamous, ventral a b s t r a C t C a s e r e P o r t FingeR pad squaMous Cell CaRCinoMa: report of squamous Cell Carcinoma of the Distal Palmar Digit and review of associated risk Factors, mimickers, and treatment of squamous Cell Carcinoma of Ventral Hand Digits by philip R. Cohen, Md, and s. BRian Jiang, Md Drs. Cohen and Jiang are with the Department of Dermatology at the university of California san Diego, in la Jolla, California. J Clin Aesthet Dermatol. 2017;10(8):42–48 Funding: no funding was provided for this study. disClosuRes: the authors have no conVicts of interest relevant to the contents of this article. authoR CoRRespondenCe: Philip r. Cohen, mD; mitehead@gmail.com Cutaneous squamous Cell C arCinoma (sCC) is a nonmelanoma skin cancer (nmsC) that typically occurs on sun-exposed skin. in contrast, sCC and sCC in situ of the palmar aspect of the hand digits are rare. a man with sCC of the distal pad of his left four th finger is described and features associated with sCC of the ventral finger are reviewed. C ase RepoRt a 62-year-old, Fitzpatrick type i, Caucasian man presented with a mass on the palmar aspect of his left four th finger pulp. the lesion had been originally noted five years earlier and interpreted by the patient to be a war t. it progressively enlarged in size and was often painful. Cutaneous examination showed a 20mmx15mm verrucous plaque that nearly occupied the entire ventral sur face of the left four th finger from the distal interphalangeal joint to the tip of the finger (Figure 1). there was no axillar y lymphadenopathy. a 3mm punch biopsy was per formed, and the histopathology showed sCC, with invasion of atypical keratinizing epithelium into the underlying dermis. the residual cancer (Figure 2) was removed by mohs surger y using the frozen-tissue technique. Five stages were required to clear the tumor. microscopic review of the surgical specimen not only showed full-thickness keratinocyte atypia within the epidermis with islands of atypical squamous cells invading the dermis (Figure 3) but also cytologic features consistent with human papillomavirus (HPV) changes within the keratinocytes (Figure 4). the resulting wound (Figure 5) was repaired using a full-thickness skin graft derived from the

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