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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46 JCAD JouRnal oF CliniCal and aesthetiC deRMatology august 2017 • Volume 10 • number 8 C a s e r e P o r t a verrucous carcinoma 29 and another patient had a pigmented sCC in situ that clinically mimicked malignant melanoma. 5 Verrucous carcinoma of the ventral fingers. Verrucous carcinoma of the skin (also referred to as epithelioma cuniculatum or carcinoma cuniculatum) is a well-diserentiated variant of sCC that is often clinically mistaken for a wart. approximately 90 percent of these cutaneous tumors are located on the feet. However, albeit rare, they also have been observed to occur on the hands. 29 Verrucous carcinoma of the right palm and fourth finger developed in a 31-year- old construction worker, 29 and bilateral verrucous carcinoma of the ventral fingers was observed in an 81-year-old man with an associated syndactyly involving the third web space of both hands. 14 differential diagnosis of sCC of the ventral finger. mimickers of sCC of the ventral finger are listed in table 2. 5,13,16–18,20,23–25,29 in some of these individuals, the cancer was concurrently present or mimicked either a benign tumor, a malignant neoplasm, or a localized condition. Verrucae or only viral changes have also been observed pathologically in the ventral digit sCC. our patient had an intermittently painful tumor of five years duration that had progressively enlarged. a chronic wart was initially considered in the diserential diagnosis; however, the tumor symptoms, size, and location prompted the clinician to perform a taBle 3. treatment of squamous cell carcinoma of the ventral hand digits suCCessFul amputation ray 1 3,14,16,17,23 En bloc at proximal joint 8,12,18,24,25 Chemotherapy (postoperative) 12 excision mohs with microscopic examination of margins (current report) not otherwise specified 5,9,11–14,18,20,29 laser (carbon dioxide) 17 Photodynamic therapy 6 ,10,21 radiation therapy (postoperative) 2 5 tazarotene (topical, postoperative) 12 unsuCCessFul amputation below elbow 26 En bloc at proximal joint 16 Cryotherarpy (liquid nitrogen) 21 excision (mohs with microscopic examination of margins) 23 5-Vuorouracil (topical) 21 interferon alfa-2a (subcutaneous) 7 isotretinoin (oral) 17 radiation therapy 16 trichloracetic acid (topical) 20 taBle 2. Diserential diagnoses of squamous cell carcinoma (sCC) of the ventral hand digits diagnosis Case RepoRt C hronic dermatitis and keratoderma 1 3 sCC in situ of the right ventral thumb tip presented as a well-circumscribed erythematous plaque, similar in appearance to biopsy-conurmed chronic dermatitis with keratoderma on the dorsal hands and ungers of a 40-year- old Japanese woman with nonfamilial Huriez syndrome. epidermoid cyst 25 Pathology eventually conurmed the diagnosis of sCC in a 20-year-old roofer; the lesion was initially biopsied and diagnosed as a traumatically induced epidermoid cyst with a network of communicating sinuses; however, after additional repetitive hammer blows to the asected digit, the unger was amputated due to severe symptoms, and tumor was discovered. infection 16,17,23–25 tumors were interpreted as bacterial infection or coincidentally contained culture-positive pathogenic bacteria. the cancer typically presented as a draining 16,17,24 or dry 23,25 nonhealing ulcer. Clinically, the ulcerated tumors were initially considered to be cellulitis 23 or osteomyelitis; 16 indeed, most of the patients were treated—without success—with systemic antibiotics. 16,17,23,25 even skin biopsies have been misleading; the discovery of pseudoepitheliomatous hyperplasia without accompanying keratinocyte atypia has prompted clinicians to entertain the possibility of mycobacterial 17,25 or deep fungal 17 infection to also be considered. melanoma 5 Pigmented sCC in situ of the pulp of the right fourth unger in a 20-year-old white, Fitzpatrick type iii, iranian woman presented as an asymptomatic gradually enlarging lesion and had initially appeared 4 years earlier. e several of the patients with pathologic diagnosis of ventral sCC had preceding lesions that were interpreted morphologically 1 8,20 or after biopsy 2 9 and subsequently treated 20 as warts. Verruca (current report) 18,20,29 the reported patient had a lesion on his fourth unger ventral surface, which he interpreted to be a wart of 5-year duration. a biopsy, once the lesion became symptomatic, established the correct diagnosis: in addition to squamous cell carcinoma, viral cytologic features consistent with human papillomavirus (HPV) infection were noted in the mohs surgery specimen. HPV type 16-associated squamous cell carcinoma in situ was discovered in the excision specimen of a presumed wart on the unger of a 33-year old. 18 Hence, squamous cell carcinoma of the palmar digit can not only mimic a verruca, but also demonstrate the presence of concurrent HPV infection as an etiologic factor.

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