AN OVERVIEW AND OUR APPROACH IN THE TREATMENT OF MALIGNANT CUTANEOUS TUMOURS OF THE HAND

Abstract

Introduction: Diagnosis of malignant cutaneous tumours of the hand is often difficult because of the different anatomic structures present in this region and yet clinicians must be able to distinguish typical benign entities from life-threatening or limb-threatening malignant diseases. Due to the hand's complex structures located in a small area, surgeons must evaluate constantly the balance of inadequate surgery against functional and cosmetic aspects. Thus, a multidisciplinary approach is recommended for a correct diagnosis and treatment design. Materials and methods: Between 2006 and 2017, 354 consecutive patients with basal and squamous cell carcinomas, and melanoma of the hand were retrospectively analysed at the Department of Plastic and Reconstructive Surgery at the University of Palermo, treatment was surgical for all of them; also radio- and chemotherapy were necessary based on the histological diagnosis. Results: The most common tumour was basal cell carcinoma (BCCs), followed by squamous cell carcinoma (SCCs). Melanoma was the most frequent lesion diagnosed in the digits. Radical excision was the main treatment of choice. In 29 cases (11 with SCC, 18 with melanoma) axillary lymphadenectomy was performed, because of lymph nodes metastases. In the follow up, the spread of cancer to distant organs caused the death in three cases. Recurrence rate was higher in case of infiltrative SCCs and BCCs. Conclusions: The major references provide only limited information on malignant soft-tissue tumours of the hand. Our retrospective study aims to present the most commonly observed malignant soft-tissue tumours of the hand, analysing their causes, their objective and instrumental evaluation, and their treatments.