Case 6. An 84-year-old female presented to the Plastic Surgery Department following a non-healing ulcer on her right hand, wrist and forearm. She sustained a hot oil scald to both upper limbs at the age of 23 whilst living in Kenya. The burns were excised and resurfaced with a split thickness skin graft. Unfortunately, she developed an unstable scar on the right upper limb since her injury and has been managed with dressings and antibiotics. Skin biopsies were performed intermittently over the years which revealed inflammatory changes only, however, 6 years since the last skin biopsy, a 7mm thick well differentiated SCC was reported. The patient had one palpable lymph node in the right axilla however fine needle aspiration cytology and CT showed no evidence of metastasis. Due to the extensive nature of ulceration and poor skin quality of the adjacent areas it was decided that amputation of the hand at the level of the mid forearm was most appropriate. She has healed well and has showed no sign of recurrence nor metastasis 1 month post-operatively ().
Case 5. A 78-year-old female presented with a 4-month history of a crusted nail bed lesion and nail plate dystrophy of the right index finger; there was no axillary lymphadenopathy. She also suffered from type 2 diabetes, gout and hypertension. Histology revealed a moderately differentiated SCC arising from bowenoid dysplasia. Following MDT discussion, she underwent right index finger amputation through the DIPJ using a volar skin flap for coverage under local anaesthetic. The 2.3 mm thick SCC was completely excised however Bowen's disease was present at the lateral margin and was therefore treated topically. She has had no sign of recurrence or metastasis for 14 months.