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 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 ().