Prostate cancer metastasis to the distal phalanx of the left hallux: The first confirmed case and literature review

Metastases to the nail unit and distal phalanx: a systematic review

Metastases to the nail unit/distal phalanx (NU/DP), although rare, carry a poor prognosis and are frequently misdiagnosed due to variable clinical presentation. Metastases to the NU/DP may be the initial presenting sign of a new or recurrent malignancy. Since the most recent systematic review of case reports (133 patients total) was conducted in 2001, we conducted a systematic review from 1900 to 2021 (244 patients total) to assess any changes in trends in demographics, clinical presentation, and morphology and to report on more updated differential diagnoses. We also examined cases for age, sex, race, ethnicity, Fitzpatrick skin type, laterality, distribution, and diagnostic methods. The PubMed database (1900-2021) was used to detect case-level data per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We found that the most common primary tumors were lung, kidney, and esophagus. A NU/DP metastasis was the presenting sign of malignancy in 31.00% of patients without a former cancer diagnosis. Male to female ratio was 2:1, with average age at diagnosis 58 years. Metastases most often affected a single digit (79.91%), particularly the thumb, followed by the fourth digit. This systematic review corroborates that metastases to the NU/DP may be the initial presenting sign of a new or recurrent malignancy and provides updated diagnostic guidelines. NU/DP metastasis should be considered in both healthy patients and patients with a former malignancy diagnosis presenting with nail changes involving a single digit. Prompt diagnosis and treatment may improve prognosis.

A Case of Metastatic Prostate Cancer to the Distal Phalanx

Metastatic bone tumors to the hand are extremely rare. We present a case of metastatic prostate cancer to the right middle finger distal phalanx. To our knowledge, there is one other case of metastatic prostate cancer to the hand in the literature. In our case, a 59-year-old man with a history of widely metastatic prostate cancer presented to urgent care and was diagnosed with a nail plate avulsion injury. He was referred to hand surgery and treated with amputation of the right middle finger distal phalanx. The pathology reported high-grade poorly differentiated adenocarcinoma with primary lesion from the prostate.

Metastatic prostate carcinoma: A rare presentation initially misdiagnosed as a rib fracture

Metastatic prostate carcinoma mainly occurs in bone as an osteoblastic lesion or lesions in the pelvis, spine, or chest wall. We present a unique case of a singular metastatic osteolytic lesion in the rib initially misdiagnosed as a fracture in a 61-year-old male. A single rib fracture in a patient with no history of trauma should raise suspicion for metastatic disease. We would encourage prostate cancer to be included in the differential diagnosis for an osteolytic lesion in a male over the age of 40. We review the current literature on this rare presentation of bone metastasis as well as the pathogenesis of metastatic prostate carcinoma as it relates to a solitary metastatic osteolytic lesion.