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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43 JCAD JouRnal oF CliniCal and aesthetiC deRMatology august 2017 • Volume 10 • number 8 C a s e r e P o r t left lower quadrant of his abdomen. the donor and recipient sites healed without any c omplications. His follow-up physical examination two months later showed no evidence of tumor (Figure 6). disCussion sCC of the ventral fingers. sCC of the dorsal hand is common. in contrast, periungual and distal dorsal finger sCC—often associated with HPV— is only occasionally observed. 1–4 sCC on the nonsun-exposed ventral fingers is rare. Risk factors for sCC of the ventral fingers. Previously documented risk factors for sCC include arsenic ingestion, chronic scars, chronic ulcers, HPV infection, radiation therapy, reduced immunity, trauma, and ultraviolet light (e.g., sun) exposure. 5 –7 With the exception of sun exposure (which is unlikely to chronically occur to the palmar surface of the fingers), these and other risk factors have been observed in individuals with sCC of the ventral fingers (table 1). 6 –26 Carcinogen exposure. exposure to carcinogens can result in malignancy. Palmar digit sCC occurred in individuals exposed to arsenic, grease and oil, or "soluble oil." 6–9 a 49-year-old man with psoriasis and a long history of exposure to arsenic from herbal medicines developed an sCC in situ on his distal palmar right fifth finger. 7 another individual with chronic arsenism, a 74-year-old taiwanese man, also developed an sCC on the distal pad of his right index finger. 6 exposure to oil contributed to sCC developing on the ventral left thumb of a 59-year-old truck mechanic with extensive contact with grease and oil and recurrent episodes of trauma to the digit. 8 soluble-oil metalworking Vuids, which contain emulsified naphthenic or paratnic oils in water, are used for cooling and lubrication of cutting tools and the working surface. a 77-year-old man, who was employed for 50 years as a metal lathe turner working with soluble oil, developed sCCs of both ventral thumbs and five palmar digits. 9 Congenital condition. epidermolysis bullosa, Huriez syndrome, and syndactyly are congenital conditions that have been associated with the subsequent development of palmar digit sCC in adulthood. recessive dystrophic epidermolysis bullosa is a rare heritable blistering disorder characterized by subepidermal blisters that often involve the fingers and the potential for skin cancer to develop in the chronic scar tissue. a 51- year-old woman with non-Hallopeau-siemens recessive dystrophic epidermolysis bullosa developed an sCC involving both the ventral and dorsal surfaces of her right fourth finger. 10 sCCs also occurred in identical twins with recessive epidermolysis bullosa. 11 Huriez syndrome is a rare autosomal dominant genodermatosis characterized by congenital scleroatrophy of the palms and soles, palmoplantar keratoderma, and nail changes; nonfamilial patients with Huriez syndrome have also been reported. 12,13 a 31-year-old Japanese woman with nonfamilial Huriez syndrome and palmoplantar keratoderma since birth developed an sCC on her left palmar thumb and sCC in situ on her right palmar thumb. 13 in addition, a 27-year- old indian man with nonfamilial Huriez syndrome developed an sCC on the palmar surface of his left thumb. 12 syndactyly, the most common congenital abnormality of the hand, is classified as a failure of differentiation. an 81-year-old man with bilateral incomplete simple syndactyly involving the web space between his third and fourth fingers on both hands presented with verrucous sCCs affecting both the left and right palmar web spaces. 14 FiguRe 1. Distant (a) and close (b) views of squamous cell carcinoma presenting as a verrucous plaque on the ventral surface of the patient's left fourth finger nearly occupying the entire pulp of the digit from the distal phalangeal joint to the finger tip. a B FiguRe 2. Preoperative clinical delineation of squamous cell carcinoma on the distal ventral left fourth finger. the inferior/proximal circle circumscribes an elevated plaque of residual tumor. the superior/distal circle circumscribes subtle epidermal change that is also clinically suspicious for residual tumor.

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