A 46-year-old white female was referred from the dermatology clinic with a biopsy-proven squamous cell carcinoma of the left ring finger perionychium. Physical examination demonstrated erythematous scaly lesions with the absence of a nail plate at the left thumb, index finger, and ring finger as well as the right long finger, without associated lymphadenopathy (Fig ). She described chronic onychomycosis of the nails attributed to her job as a dishwasher.\nPast medical history was significant for chronic onychomycosis. Social history demonstrated a 40 pack-year smoking habit. She denied alcohol use, exposure to aniline dyes, radiation, or arsenic exposure.\nThe decision was made to biopsy all digits with scaly lesions. She was advised to stop smoking and counseled about the likely need for partial amputation. Pathology demonstrated squamous cell carcinoma of all biopsy sites. Wide local excision with partial amputation was performed on all involved digits with preservation of the left thumb interphalangeal joint and left index finger, left ring finger, and right long finger proximal interphalangeal (Fig ).\nSurgical pathology demonstrated positive margins on the left thumb and left ring finger necessitating reexcision. All final margins are clear and all incisions have healed nicely (Fig ).\nDue to the extensive nature of the patients' cancer and longstanding history, we elected to perform amputation as opposed to other treatment modalities, which will be described further in the discussion. The patient is currently about 1 year out from surgery and has returned to normal activities and displays no evidence of recurrence.
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 ().