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 2. A 71-year-old female was referred from Dermatology with a 5-month history of a fixated swelling on the right index finger and an ulcerated lesion involving the second webspace; a biopsy showed this to be a well differentiated SCC. There was no clinical or radiological evidence of lymphatic or metastatic spread. The patient underwent amputation of the right index finger at the level of the metacarpal phalangeal joint (MCPJ) under general anaesthesia. Histological analysis reported a completely excised moderately differentiated SCC measuring 9.9mm thick. She was discharged home the same day and 48 months later has had no sign of recurrence or metastasis ().