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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45 JCAD JouRnal oF CliniCal and aesthetiC deRMatology august 2017 • Volume 10 • number 8 C a s e r e P o r t other cases of men with palmar digit sCC in situ have been reported; many of these i ndividuals (or their sexual partners) also had genital sCC in situ associated with the same HPV type. 1 5,18,19 in addition, women with subungual and/or dorsal finger HPV associated sCC in situ have been described to also have genital dysplasia secondary to the same virus. 1,27,28 a 60-year-old man with a hypertrophic scaling plaque on his volar and medial finger was documented to have HPV type 16, by in- situ deoxyribonucleic acid (Dna) hybridization, in the sCC in situ from both his digit and penis. 19 HPV type 16 was also confirmed by in-situ hybridization and polymerase chain reaction in the sCC in situ of the finger and the bowenoid papulosis of the perianal area of a cardiac transplant patient. 15 excisional biopsy of a presumed recurrent wart on a nondominant finger of a 33-year-old man showed HPV type 16- associated sCC in situ; additional history revealed that his female partner previously had viral-related cervical lesions. 18 Radiation exposure. sCC of the palmar finger has been observed in patients exposed to radiation. 7,20–23 this includes not only exposure to radiopharmaceuticals and ionizing radiation but also exposure to ultraviolet a radiation: 1) a nurse who worked for five years in a metabolic radiotherapy unit preparing the injectable substances (e.g., thallium and metastable technetium 99) and administering radioactive tablets for thyroid tumor therapy developed an sCC in situ on the right proximal palmar third finger five years later; 20 2) a 75-year-old woman who worked for more than 30 years as an X-ray technologist holding newborns during radiological studies developed an sCC on the flexor surface of her right middle finger 15 years after retiring; 23 3) a 63-year-old pediatrician who used radioscopy for 20 years in his practice and handled children without the protection of lead gloves, presented with a radiation-associated sCC in situ in addition t o biopsy-confirmed chronic radiodermatitis of the distal palmar right middle finger; 21 and 4) a 49-year-old man with arsenic exposure whose psoriasis had been treated with psoralen and ultraviolet a radiation developed sCC in situ of his distal palmar right fifth finger. 7 Trauma. severe, repetitive, and/or chronic trauma to the affected digit has been observed in some of the individuals who subsequently developed sCC of the ventral surface of that digit. 14,16,17,24–26 the development of cancer at these sites of trauma is likely similar to the occurrence of cutaneous sCC observed in chronic scars, ulcers (marjolin ulcers), or sinuses following trauma to the skin site. Chronic irritation to the affected area is postulated to promote malignant transformation. the latency period between the initial injury and subsequent diagnosis of cancer in patients with marjolin ulcers or similar injuries is typically long—often ranging from 20 to 30 years. 16,17,24 in contrast, the latency period between injury and cancer detection was shorter in five of the six patients with trauma-associated sCC of the ventral finger ranging from six months to 12 years (median=10 years). 16,17,24–26 However, in an 81-year-old man with congenital syndactyly and chronic skin changes as a result of friction, the latency period was over eight decades. 14 sCC of the pulp space of the left index finger developed in a roofer following repeat hammer blows to the same finger six months and 12 years earlier. 25 in addition, squamous cell carcinomas have subsequently developed at the sites of wound-producing injuries secondary to knife cut, 26 cement, 17 or splinter. 16 idiopathic sCC of the ventral fingers. sCC of the ventral finger has rarely been described in patients without an apparent tumor-associated risk factor. one patient had FiguRe 5. tumor-free wound after 5 mohs stages a FiguRe 6. Distant (a) and close (b) views of distal ventral fourth finger showing complete healing of the wound 2 months after repair using a full-thickness skin graft B

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