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 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 ().