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 ().
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.