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Mortada H, Aldihan R, Alhindi N, Abu alqam R, Alnaim MF, Kattan AE. "Basal cell carcinoma of the hand: A systematic review and meta-analysis of incidence of recurrence". JPRAS Open 2022; 35:42-57. [PMID: 36685723 PMCID: PMC9851839 DOI: 10.1016/j.jpra.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 11/26/2022] [Indexed: 12/03/2022] Open
Abstract
Background Hand basal cell carcinoma is a rare and complex disorder. Due to the hand's anatomical features, managing hand BCC is challenging. Therefore, we have conducted this systematic review to investigate various clinical characteristics, investigations, and treatment options related to hand BCC. Furthermore, a meta-analysis was used to provide pooled recurrence rates. Methods We conducted this review per the International Prospective Register of Systematic Reviews (PROSPERO) guidelines. This study performed a systematic literature review in February 2022 using the following electronic databases: Cochrane, MEDLINE, and EMBASE. Key terms include hand basal cell carcinoma, basal cell carcinoma, management, outcome, and recurrence. We evaluated articles according to predefined quality criteria. Results The study included 9725 patients and 51 published articles. A total of 35 case reports, 2 case series, 1 prospective study, and the remaining retrospective studies were evaluated. An asymptomatic skin lesion was the main complaint. In 10 studies, Moh surgery was the most frequently used treatment method. In the seven studies included in the meta-analysis, the overall incidence rate of recurrence among the included patients was 1.49 cases per year. Conclusion The optimal extent of surgical treatment is still controversial, though an early biopsy can help identify lesions at an early stage. It is the first study to provide occurrence rates based on a meta-analysis. Developing treatment guidelines for BCC of the hand will be the focus of future research.
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Affiliation(s)
- Hatan Mortada
- Division of Plastic Surgery, Department of Surgery, King Saud University Medical City, King Saud University and Department of Plastic Surgery & Burn Unit, King Saud Medical City, Riyadh, Saudi Arabia
| | - Rema Aldihan
- College of Medicine, King Saud University, Riyadh, Saudi Arabia,Corresponding author at: College of medicine, King Saud University, Riyadh, Saudi Arabia 12445, Riyadh, Saudi Arabia.
| | - Nawaf Alhindi
- College of Medicine, King Abdulaziz University, Rabigh, Saudi Arabia
| | - Rakan Abu alqam
- College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Abdullah E. Kattan
- Division of Plastic Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Abstract
Melanomas only account for 4% of all dermatologic cancers yet are responsible for 80% of deaths. Notably, melanomas of the hand and foot have a worse prognosis when compared with melanomas of other anatomic regions. Likely this is due to intrinsic biologic characteristics, delayed diagnosis, difficult surgical excision due to delicate anatomy, and lack of definitive diagnostic and therapeutic guidelines. The most common locations of melanoma of the hand, in order of decreasing frequency, are subungual area, dorsal surface, and palmar surface. The most common locations of melanoma of the foot are the plantar surface, dorsal surface, and subungual area, in decreasing frequency. Diagnosis of melanoma of the hand and foot can be difficult because the traditional "ABCDE" (asymmetric shape, border, color, diameter, evolution) rules do not apply. Newer acronyms have been proposed in literature including "CUBED" (colored, uncertain, bleeding, enlarged, delayed) and "ABC rule for Subungual Melanoma." Once diagnosed, treatment is primarily surgical excision and reconstruction. The goal for the surgeon is to maintain the function and anatomy of the hand or foot.
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Squamous Cell Carcinoma of the Hand: A Retrospective Study in Immunosuppressed and Immunocompetent Individuals. Dermatol Surg 2021; 46:1014-1020. [PMID: 32028479 DOI: 10.1097/dss.0000000000002336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Cutaneous squamous cell carcinoma (SCC) of the hand presents a treatment challenge because of the anatomical complexity of this location. Immunosuppressed patients are disproportionately affected by cutaneous SCC. Existing data on SCC of the hand are primarily presented in the orthopedic literature, and may thus be affected by referral bias. OBJECTIVE Characterization of epidemiology and treatment outcomes for hand versus nonhand cutaneous SCC in immunosuppressed versus immunocompetent patients, across all clinical departments. MATERIALS AND METHODS Single-institution retrospective cohort study of cutaneous SCC evaluated over 3 years and hand SCC over an additional 5 years. RESULTS A cohort of 522 hand SCC cases (1,746 total SCC) was ascertained among 1,064 patients, of whom 175 were immunosuppressed. Occurrence on the hand was more common for SCC arising in immunosuppressed versus immunocompetent patients (38% vs 24% of cases respectively). Hand SCC cases demonstrated balanced laterality and comparable spectra of differentiation regardless of immunosuppression. No cases of hand SCC metastasis were observed over greater than 2 years' mean follow-up, and digital amputation was only required in approximately 1% of hand SCCs. CONCLUSION In our cohort, assessment of hand SCC across all clinical departments suggests more favorable prognosis than reflected in the previous literature.
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Nolan G, Kiely A, Totty J, Wormald J, Wade R, Arbyn M, Jain A. Incomplete surgical excision of keratinocyte skin cancers: a systematic review and meta‐analysis*. Br J Dermatol 2020; 184:1033-1044. [PMID: 33131067 DOI: 10.1111/bjd.19660] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Keratinocyte or nonmelanoma skin cancer (NMSC) is the commonest malignancy worldwide. The usual treatment is surgical excision. Current guidelines underestimate incomplete excision rates. OBJECTIVES We aimed to determine the risk of incomplete excision of NMSCs through a systematic review and meta-analysis of primary clinical studies. METHODS A PRISMA-compliant systematic review and meta-analysis was performed using methodology proposed by Cochrane (PROSPERO CRD42019157936). A comprehensive search strategy was applied to MEDLINE, Embase, Scopus, CINAHL, EMCare, Cochrane Library and the grey literature (January 2000-27 November 2019). All studies were included except those on Mohs micrographic surgery, frozen section or biopsies. Abstract screening and data extraction were performed in duplicate. Risk of bias was assessed using a tool for prevalence/incidence studies. The primary outcome was the proportion of incomplete surgical excisions. A random-effects model for pooling of binomial data was used. Differences between proportions were assessed by subgroup meta-analysis and meta-regression, which were presented as risk ratios (RRs). RESULTS Searching identified 3477 records, with 110 studies included, comprising 53 796 patients with 106 832 basal cell carcinomas (BCCs) and 21 569 squamous cell carcinomas (SCCs). The proportion of incomplete excisions for BCC was 11·0% [95% confidence interval (CI) 9·7-12·4] and for SCC 9·4% (95% CI 7·6-11·4). Proportions of incomplete excisions by specialty were: dermatology, BCCs 6·2% and SCCs 4·7%; plastic surgery, BCCs 9·4% and SCCs 8·2%; general practitioners, BCCs 20·4% and SCCs 18·9%. The risk of incomplete excision for general practitioners was four times that of dermatologists for both BCCs (RR 3·9, 95% CI 2·0-7·3) and SCCs (RR 4·8, 95% CI 1·0-22·8). Studies were heterogeneous (I2 = 98%) and at high risk of bias. CONCLUSIONS The proportion of incomplete excisions is higher than previously reported. Excisions performed by specialists may lower the risk of incomplete excision.
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Affiliation(s)
- G.S. Nolan
- Department of Plastic and Reconstructive Surgery Whiston HospitalSt Helens and Knowsley Teaching Hospitals NHS Trust Warrington Road Prescot Merseyside UK
| | - A.L. Kiely
- Department of Plastic and Reconstructive Surgery Queen Elizabeth HospitalUniversity Hospitals Birmingham NHS Trust Edgbaston UK
| | - J.P. Totty
- Department of Plastic and Reconstructive Surgery Hull University Teaching HospitalsCastle Hill Hospital Cottingham East Riding of Yorkshire UK
| | - J.C.R. Wormald
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford Oxford UK
- Department of Plastic and Reconstructive Surgery Stoke Mandeville HospitalBuckinghamshire Healthcare NHS Trust Aylesbury UK
| | - R.G. Wade
- Leeds Institute for Medical Research University of Leeds Leeds UK
- Department of Plastic and Reconstructive Surgery Leeds Teaching Hospitals NHS Trust Leeds UK
| | - M. Arbyn
- Unit of Cancer Epidemiology Belgian Cancer Centre Sciensano Brussels Belgium
| | - A. Jain
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford Oxford UK
- Department of Plastic and Reconstructive Surgery Charing Cross and St Mary’s HospitalsImperial College Healthcare NHS Trust London UK
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Wollina U, Tempel S, Albert W, Hansel G, Heinig B. Advanced Ulcerated Squamous Cell Carcinoma of the Hand with Locoregional Axillary Lymph Node Metastasis - Case Report and Literature Review. Open Access Maced J Med Sci 2019; 7:791-793. [PMID: 30962841 PMCID: PMC6447345 DOI: 10.3889/oamjms.2019.200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 03/02/2019] [Accepted: 03/03/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND: Cutaneous squamous cell carcinoma (SCC) of the hand is the most common soft-tissue malignancy in this particular region. A literature survey suggested a higher rate of metastases in advanced SCC of the hand compared to head-and-neck cutaneous SCC. CASE REPORT: An 84-year-old man presented with an ulcerated firm tumour on the dorsum of his right hand. A diagnostic biopsy confirmed the diagnosis SCC. Imaging suggested an involvement of the tendons of digits 3 and 4. A diagnostic ultrasound suggested a loco-regional axillary lymph node metastasis. After discussion in the interdisciplinary tumour board, amputation of the affected digits followed by lymph node excision was recommended. CONCLUSIONS: Advanced SCC of the hand requires interdisciplinary management. Amputation is part of the surgical spectrum in advanced cases.
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Affiliation(s)
- Uwe Wollina
- Academic Teaching Hospital Dresden, Department of Dermatology and Allergology, Dresden, Germany
| | - Sven Tempel
- Department of Trauma, Reconstructive, and Hand Surgery, Städtisches Klinikum Dresden, Dresden, Germany
| | - Wolfgang Albert
- Department of General, Visceral and Thoracic Surgery, Städtisches Klinikum Dresden, Dresden, Germany
| | - Gesina Hansel
- Academic Teaching Hospital Dresden, Department of Dermatology and Allergology, Dresden, Germany
| | - Birgit Heinig
- Center for Physical and Rehabilitative Medicine, Städtisches Klinikum Dresden, Dresden, Germany
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Metastatic Cutaneous Squamous Cell Cancer with Peritoneal Carcinomatosis: A Case Report. REPORTS 2019. [DOI: 10.3390/reports2010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Peritoneal involvement as a metastatic site of squamous cell skin cancer is exceptionally rare. The current work analyzes a 52-year old male with high-risk cutaneous squamous cell nose carcinoma (cSCC) that was initially treated with surgery and platinum-based concurrent chemoradiation. Five years later, he presented jaundice and hypercalcemia. Further imaging revealed diffused liver, peritoneal and paraaortic lymph node metastases without evidence of locoregional recurrence. The patient underwent liver biopsy, which confirmed the diagnosis. High-risk features for metastasizing can be considered the maximum clinical diameter, the anatomical subsite (localization of the primary tumor in the ear and retroauricular area, cheek and lip are considered to significantly increase the risk of distant metastasis), poor histological differentiation, perineural invasion and lesions with a thickness of more than 2.0 mm. Late relapse that involves only disseminated abdominal disease is very uncommon and may justify closer follow-up and more aggressive chemotherapy in high-risk patients.
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Feldmann R, Wruhs M, Peinhaupt T, Stella A, Breier F, Steiner A. Carcinoma Cuniculatum of the Right Thenar Region with Bone Involvement and Lymph Node Metastases. Case Rep Dermatol 2017; 9:225-230. [PMID: 29282396 PMCID: PMC5731142 DOI: 10.1159/000484038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/08/2017] [Indexed: 01/11/2023] Open
Abstract
Squamous cell carcinoma (SCC) is the second most common type of skin cancer after basal cell carcinoma (BCC). The overall prevalence of BCC is 3 times higher than that of SCC, but this can vary when looking at specific locations such as the hand, where SCC is much more common than BCC. Carcinoma (or epithelioma) cuniculatum is a rare variant of SCC. It was originally described as a verrucous carcinoma of the soles. Exceptionally, it can arise in other parts of the skin. We report a rare case of carcinoma cuniculatum of the right thenar region with bone and lymph node involvement.
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Affiliation(s)
- Robert Feldmann
- Department of Dermatology, Municipal Hospital Hietzing, Vienna, Austria
| | - Marlies Wruhs
- Department of Dermatology, Municipal Hospital Hietzing, Vienna, Austria
| | - Tobias Peinhaupt
- Department of Dermatology, Municipal Hospital Hietzing, Vienna, Austria
| | - Alexander Stella
- Department of Dermatology, Municipal Hospital Hietzing, Vienna, Austria
| | - Friedrich Breier
- Department of Dermatology, Municipal Hospital Hietzing, Vienna, Austria
| | - Andreas Steiner
- Department of Dermatology, Municipal Hospital Hietzing, Vienna, Austria
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Cheo T, Ng I, Ooi KH, Ai Choo B. Long-term remission after low dose radiotherapy in patient with extensive squamous cell carcinoma of the hand: A case report. Medicine (Baltimore) 2016; 95:e5013. [PMID: 27684868 PMCID: PMC5265961 DOI: 10.1097/md.0000000000005013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RATIONALE FOR CASE REPORT Cutaneous Squamous Cell Carcinoma (cSCC) of the hand is uncommon and tends to have poorer outcomes. Surgical resection with wide margins around the tumor is recommended as the treatment of choice, and radiotherapy is considered second-line treatment. Nodal evaluation involves dissection necessitating some morbidity. The role of less invasive modalities of nodal evaluation is not well established. CASE PRESENTATION We report a case of locally advanced case of hand cSCC. Positron emission tomography-computed tomography (PET-CT) showed disease involving full thickness of the hand as well as the ipsilateral axillary node. To achieve adequate surgical margins would have necessitated amputation at the wrist, which the patient did not consent to. Instead, he was given a two-and-a-half week course radiotherapy to the hand without axillary radiation. With the radiotherapy treatment, he managed to achieve complete remission of disease while retaining full function of the hand, which was maintained at 22 months post-treatment. MAIN LESSONS CSCC of the hand is uncommon and challenging to treat. Radiotherapy is a highly effective treatment modality which is able to achieve functional preservation. Care should be taken when evaluating nodal status using PET-CT.
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Affiliation(s)
- Timothy Cheo
- Department of Radiation Oncology, National University Health System
- Department of Radiation Oncology, Tan Tock Seng Hospital, Singapore
- Correspondence: Timothy Cheo, National University Health System, Singapore (e-mail: )
| | - Ivy Ng
- Department of Radiation Oncology, National University Health System
- Department of Radiation Oncology, Tan Tock Seng Hospital, Singapore
| | - Kiat Huat Ooi
- Department of Radiation Oncology, National University Health System
| | - Bok Ai Choo
- Department of Radiation Oncology, National University Health System
- Department of Radiation Oncology, Tan Tock Seng Hospital, Singapore
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Fino P, Spagnoli AM, Ruggieri M, Marcasciano M, Scuderi N. Bilateral hand squamous-cells carcinoma in patient affected with non-Hodgkin lymphoma. Case report and literature review. G Chir 2015; 36:172-82. [PMID: 26712073 DOI: 10.11138/gchir/2015.36.4.172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Squamous-cell skin cancer is the most frequent tumor in the hand. It occurs on sun-damaged skin, especially in lightskinned individuals with a long history of chronic sun exposure. CASE REPORT We describe a case of bilateral hand squamous-cell carcinoma in a elderly patient affected with non-Hodgkin's lymphoma, who underwent several non-successful surgical treatment, radiotherapy and at the least, amputation of right hand for rapid clinical evolution after radiotreatment. Available literature on the subject has been reviewed. RESULTS In our case, after several non-successful treatment, elective amputation at the distal third of forearm was performed. We reviewed 56 items including books, original articles, reviews, cases report. CONCLUSIONS Current evidence on treatment of hand squamouscells carcinoma is to perform a first radical surgical treatment in order to avoid recurrence/metastasis and to achieve a safer level of amputation thus increasing the surface area of healthy tissue available for eventually subsequent reconstruction/prosthesization.
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Longhurst WD, Khachemoune A. An unknown mass: the differential diagnosis of digit tumors. Int J Dermatol 2015; 54:1214-25. [DOI: 10.1111/ijd.12980] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 12/03/2014] [Accepted: 01/17/2015] [Indexed: 12/23/2022]
Affiliation(s)
- William D. Longhurst
- University Hospitals Case Medical Center; Case Western Reserve University; Cleveland OH USA
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Sinno S, Wilson S, Billig J, Shapiro R, Choi M. Primary melanoma of the hand: An algorithmic approach to surgical management. J Plast Surg Hand Surg 2015; 49:339-45. [DOI: 10.3109/2000656x.2015.1053396] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Skin cancer accounts for most hand cancers. Prompt recognition of lesions with malignant potential can lead to early treatment and decreased disease burden. Understanding the appropriate diagnostic algorithm for a given lesion facilitates accurate staging, which guides therapy. A multidisciplinary approach that includes hand surgeons, dermatologists, oncologists, and radiation oncologists is often necessary to manage advanced disease. For most invasive tumors, the primary treatment modality remains surgical excision; however, several effective nonsurgical treatments exist for management of unresectable or low-grade cancers.
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Turner JB, Rinker B. Melanoma of the Hand: Current Practice and New Frontiers. Healthcare (Basel) 2014; 2:125-38. [PMID: 27429265 PMCID: PMC4934499 DOI: 10.3390/healthcare2010125] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 02/04/2014] [Accepted: 02/17/2014] [Indexed: 12/17/2022] Open
Abstract
Melanoma of the hand represents a complicated clinical entity. Anatomic features of the hand create challenges in successful management of melanoma not encountered elsewhere in the body. The objectives of this article are to outline current standards for managing melanoma of the hand including diagnosis, surgical, and chemotherapeutic management. Particular emphasis will be placed on currently debated topics of the role of sentinel lymph node biopsy, the role of Mohs micrographic surgery, tissue sparing management of subungual melanoma, and the consideration of melanoma of the hand as a distinct entity based on clinical and molecular studies.
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Affiliation(s)
- John Brad Turner
- Division of Plastic Surgery, University of Kentucky College of Medicine, 740 S. Limestone Street, Lexington, KY 40536, USA.
| | - Brian Rinker
- Division of Plastic Surgery, University of Kentucky College of Medicine, 740 S. Limestone Street, Lexington, KY 40536, USA.
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Surgical options for malignant skin tumors of the hand. Arch Plast Surg 2013; 40:238-43. [PMID: 23730600 PMCID: PMC3665868 DOI: 10.5999/aps.2013.40.3.238] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 04/09/2013] [Accepted: 04/16/2013] [Indexed: 11/28/2022] Open
Abstract
Background Primary malignant tumors of the hand, although unusual, may present varied and often complex clinical problems. The main treatment modality of skin cancer of the hand has changed. Methods We retrospectively reviewed the medical records of 43 patients who underwent surgery for malignant skin tumors of the hand during an 18-year period, from September 1994 to February 2012. The characteristics of the tumor, methods of reconstruction, and long-term results were reviewed. Results We had 43 patients with 27 melanomas, 14 squamous cell carcinomas, and 2 sarcomas. Their ages ranged from 19 to 74 years (mean, 53.4±14.5 years), from 46 to 79 years (mean, 59.7±9.6 years), and from 15 to 43 years (mean, 29±19.8 years), respectively. Thirty-four cases occurred on the fingertip (16 of those cases on the thumb), 5 cases occurred on the palm, and 4 cases on the dorsum of the hand. Amputation was most frequently used in early cases, but recently, tissue-sparing excision has been performed frequently. The incidence of local recurrence was 3 cases and distant metastasis was 1 case, and the 5-year survival rate was 100%, except in 4 cases due to follow-up loss. Conclusions The principles of treatment-to be curative and to preserve function and appearance-are important points. "Preservative surgery" preserves function and cosmesis of the involved finger or hand dorsum or palm. Preservative surgery not only emphasizes less resection and surgery of a smaller scale, but also optimal reconstruction of the soft tissue defect of the digit.
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