In March 2005 a 68-year-old female patient presented to our outpatient clinic with a 4 × 5 cm sized exulcerating tumor at the left hand in the area of a congenital symbrachydactyly at the digiti II and III. (). The tumor showed rapid progression and caused local pain. About four months prior to admission on our clinic the tumor was seen for the first time by a physician. The tumor was initially diagnosed as seborrheic keratosis, and for months it was treated with topical medication only. Additionally the patient was treated with antibiotics because of local inflammatory signs. The patient herself was in good general condition and had no B-symptoms and no increased lymph nodes were palpable.\nAn urgent biopsy of the tumor was performed, which confirmed our suspicion of a squamous cell carcinoma. Preoperative staging including MRI of the affected hand (Figures and ), plain thoracic X-ray, abdominal ultrasound scan, and thoracoabdominal CT scan was performed. We diagnosed a soft-tissue tumor with evidence of malignancy, but with no evidence of bony infiltration nor intrathoracic or intra-abdominal metastasis. However we detected an enlarged sentinel lymph node in the left axilla. Further workup for abnormal lymph nodes showed two suspicious axillary enhancements.\nUnder curative intention we performed an amputation of the second and third ray of the left hand at the metacarpal level and additionally an axillar revision and lymph node dissection under general anesthesia.\nThe definite histological examination confirmed the preoperative suspicion of a squamous cell carcinoma, fortunately without affection of any lymph nodes (histological TNM staging: pT4 N0 M0 G1-2).\nThe postoperative course was without complications except a recurring lymphoid seroma developing in the left axilla, which was successfully treated by repetitive aspiration. With intensive ergotherapy the patient reached an excellent functional result of the operated left hand (Figures and ). 9 years after the surgery there was no clinical sign of any tumor recurrence. The patient could perform fine motor skills like sewing. The measurements of the motor function showed decreased strength of the operated left hand compared with the dominant right hand with finger pinch side-to-end (left 3.5 kg and right 7 kg), end-to-end (left 2 kg and right 5 kg), and hand grip (left 11 kg and right 26 kg).
Case 3. A 67-year-old male was referred by a Dermatologist with a 2-month history of biopsy proven squamous cell carcinoma present on each hand. The lesion on the right hand involved the middle finger and third webspace and the lesion on the left hand involved only the dorsum. There was no sign of axillary lymphadenopathy bilaterally. This gentleman suffered from COPD, had a tracheostomy in situ for previous T4 vocal cord tumour and was a heavy smoker.\nHe underwent amputation of the right middle and ring fingers at the level of the MCPJ and was reconstructed using a fillet flap from ring finger. Histology reported a moderately differentiated, 17 mm thick SCC. His recovery was unmarkable and recurrence was not detected within the first post-operative year. Unfortunately, he died following sequelae of the vocal cord tumour ().