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 3. A 67-year-old male was referred by a Dermatologist with a 2-month history of biopsy proven squamous cell carcinoma present on each hand. The lesion on the right hand involved the middle finger and third webspace and the lesion on the left hand involved only the dorsum. There was no sign of axillary lymphadenopathy bilaterally. This gentleman suffered from COPD, had a tracheostomy in situ for previous T4 vocal cord tumour and was a heavy smoker.\nHe underwent amputation of the right middle and ring fingers at the level of the MCPJ and was reconstructed using a fillet flap from ring finger. Histology reported a moderately differentiated, 17 mm thick SCC. His recovery was unmarkable and recurrence was not detected within the first post-operative year. Unfortunately, he died following sequelae of the vocal cord tumour ().