Case 4. A 75-year-old female with a background of scleroderma, Raynaud's disease, hypothyroidism and type 2 diabetes was referred via her rheumatologist for pain and onycholysis of the right thumb. On examination the underlying nail bed was unremarkable aside from some variation in colour; there was no axillary lymphadenopathy. Surprisingly a biopsy of the nail bed revealed a 3.3mm thick moderately differentiated SCC. Following MDT discussion, the patient underwent amputation of the distal phalanx under local anaesthetic. The stump healed well and has showed no evidence of recurrence or metastasis at last clinic review 22 months later ().
Case 1. An 84-year-old female presented with a 5 year history of a fungating lesion on the dorsum of her right hand. The lesion was large and fixation to underlying structures was reported; no axillary lymphadenopathy was present. A biopsy, not unexpectedly reported a poorly differentiated, 13.7mm thick SCC and MRI revealed extensive involvement of the second and third metacarpals and interossei which extended volarly. CT chest, abdomen and pelvis showed no evidence of metastatic spread. Following MDT and patient discussion a distal forearm amputation was undertaken. Recovery was unremarkable and there has been no recurrence or metastatic spread since last clinical review at 48 months ().