Skin Cancer and Related Lesions-Cutaneous Malignancies of the Upper Extremity

Cutaneous Malignancies of the Upper Extremity

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Cutaneous malignancies are the most common primary malignancies of the hand. This article reviews the diagnosis and treatment of the three most common cutaneous malignancies: basal cell carcinoma, squamous cell carcinoma, and malignant melanoma. The evaluation of cutaneous lesions should document the history of the lesion and assess risk factors for skin cancers, such as sun exposure and previous skin cancers. The goal of surgery is to perform complete excision of the tumor while maintaining the narrowest margin possible to maximize function and appearance. Small nonmelanoma skin cancers can usually be removed with full-thickness skin excision. For melanomas, vertical margins typically include the subcutaneous tissue up to but not including deeper layers. Lymph node drainage in the upper extremity includes the epitrochlear nodes and extends proximally into the axillary region. When a lesion is excised, it should be sent for pathological evaluation to determine if the margins are free of tumor. The use of tourniquet in upper-limb surgery is routine. Small tumors can often be removed with an ellipse of normal skin, while larger tumors may require incisional biopsy. The simplest method of wound closure is chosen, and monitoring for recurrence is important. Finger lesions and subungual lesions can pose difficulties in obtaining recommended margins and may require amputation. Surgical excision with pathologic evaluation is a cost-effective method for treating most skin cancers, while electrodessication and curettage and cryosurgery are not commonly used by hand surgeons. Overall, hand surgeons play a unique role in treating cutaneous malignancies of the hand, as they have the expertise to perform tumor resection while preserving or restoring hand function.

Keywords

cutaneous malignancies

hand

diagnosis

treatment

basal cell carcinoma

squamous cell carcinoma

malignant melanoma

skin cancers

surgery

excision