Soft Tissue Tumors of the Hand. 2. Malignant

Abstract

Soft tissue tumors of the hand arise from skin, subcutaneous tissue, tendons, nerve, and blood vessels. Many of these lesions occur on other parts of the body; however, the hand remains a unique site because these tumors have symptoms, appearances, treatments, and prognoses that may be quite different than when on other parts of the body. Their characteristics and the severity of symptoms vary markedly depending on the exact location, size, and type of tumor-and many of these tumors can have multiple forms of presentation. Two articles are intended to provide an overview of benign (previous article) and malignant tumors (this article) of the hand. The rarer and more deleterious tumors are discussed in detail while the common tumors and epidermal lesions with which practitioners are familiar are briefly overviewed. At the completion of these review articles, participants should be able to identify and diagnose various benign and malignant hand tumors as well as understand the accepted current treatment of these growths.

Hand Tumors

“…17,22,23 Large (>2 cm) or high-grade basal cell carcinomas require margins of 6 mm, with some authors advocating the use of Mohs micrographic surgery to maximize tissue preservation. 15,23 Nail unit involvement is extremely rare. 24,25 Squamous Cell Cancer Squamous cell cancers comprise nearly 75 percent of all malignant skin lesions found in the hand.…”

“…[16][17][18][19] Conservative treatment modalities such as 5-fluorouracil, imiquimod, and intralesional methotrexate are considered second-line therapies, and early surgical excision is recommended. 15,17 …”

“…15,17 For small or multiple lesions, treatment with cryotherapy, electrodesiccation and curettage, and radiotherapy have demonstrated low rates of recurrence. 15,20,21 Surgical excision is the preferred method of treatment. Small (<2 cm) or low-grade lesions require margins of 4 mm to prevent local recurrence.…”

“…Locations include sun-exposed areas such as the dorsum of the hand. 15,16 Histologically, these lesions are difficult to distinguish from invasive squamous cell carcinoma, despite their tendency to regress. 15,17 Current theory suggests reclassification of keratoacanthomas as either premalignant lesions or, furthermore, as a subtype of squamous cell carcinoma.…”

“…15,16 Histologically, these lesions are difficult to distinguish from invasive squamous cell carcinoma, despite their tendency to regress. 15,17 Current theory suggests reclassification of keratoacanthomas as either premalignant lesions or, furthermore, as a subtype of squamous cell carcinoma. [16][17][18][19] Conservative treatment modalities such as 5-fluorouracil, imiquimod, and intralesional methotrexate are considered second-line therapies, and early surgical excision is recommended.…”