Background: Skin cancers of the hand are uncommon and poorly documented. The objective of this study was to review a large cohort of patients with hand skin malignancies to determine tumor characteristics, management techniques, and outcomes.
Methods: A retrospective review of consecutive patients with surgically excised primary cutaneous hand malignancies at the John Radcliffe Hospital between 1993 and 2010 was performed. Records were reviewed to determine tumor characteristics, demographics, and management details. Outcome parameters included margins and completeness of excision, recurrence, metastatic spread, and survival.
Results: A total of 407 patients (65.8 percent male; mean age, 72.2 ± 0.7 yr) presented with 541 primary cutaneous hand malignancies and were followed up for a mean period of 24 months. Half the cohort had previous skin cancers and almost one in five developed further hand skin cancers. Squamous cell carcinoma comprised 78.0 percent, basal cell carcinoma 11.3 percent, and melanoma 3.9 percent of cases. Incidence was highest on the dorsum of the hand. Surgical margins were proportionate to tumor size, and most defects required soft-tissue reconstruction. Recurrence was uncommon in melanoma and rare in squamous and basal cell carcinomas. Lymph node metastasis and death were rare in patients with squamous cell carcinoma but relatively common in those with melanoma.
Conclusions: Squamous cell carcinomas are the most common skin malignancy of the hand, frequently require soft-tissue reconstruction, and those occurring in the web spaces or on the dorsum of the proximal phalanges are more sinister malignancies with a greater propensity for metastatic spread.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, IV.
Oxford, United Kingdom; and Melbourne, Australia
From the Oxford University Department of Plastic, Reconstructive, and Hand Surgery, John Radcliffe Hospital; the Department of Cellular Pathology, John Radcliffe Hospital; and the University of Melbourne.
Received for publication December 17, 2011; accepted January 3, 2012.
Presented at the Australian Hand Surgery Society Annual Conference, in Bunker Bay, Western Australia, March 16 through 20, 2011; the British Society for Surgery of the Hand Spring Scientific Meeting, in Manchester, United Kingdom, March 31 through April 1, 2011; the Federation of European Societies for Surgery of the Hand Annual Conference, in Oslo, Norway, May 26 through 28, 2011; the British Association of Plastic, Reconstructive, and Aesthetic Surgeons Summer Scientific Meeting, in Oxford, United Kingdom, July 6 through 8, 2011; and the American Society for Surgery of the Hand Annual Meeting, in Las Vegas, Nevada, September 8 through 10, 2011.
Disclosure: The authors have no financial interest to declare in relation to the content of this article.
Simon J. Maciburko, B.Med.Sci.; P.O. Box 326, Ivanhoe, Victoria, Australia 3079, firstname.lastname@example.org