Table 3.

Treatment Recommendations for Patients With Acrometastasis to the Hand and Wrist.

Recommendation number	Description of recommendation
Recommendation no. 1	Patients with a history of cancer, particularly of the lung, kidney, breast, colon, or esophagus presenting with a new painful digit, should undergo initial imaging with an x-ray ± a biopsy to rule out acrometastasis.
Recommendation no. 2	If infection is suspected in a patient with a history of cancer, particularly those listed above, consider obtaining a biopsy of the tissue you culture.
Recommendation no. 3	Acrometastasis should be on the differential diagnosis for patients diagnosed with infection who are unresponsive to treatment, particularly if the patient has significant risk factors for malignancy.
Recommendation no. 4	Patients with risk factors for lung cancer should be screened for lung cancer if they present with a finger lesion suspicious for metastasis.
Recommendation no. 5	Treatment of acrometastasis should focus on symptom relief and function. Treatment should serve as an adjunct to systematic therapy directed by the primary malignancy and local tumor board.
Recommendation no. 6	Amputation should be performed to the nearest joint or to minimize tissue loss. There has been no superiority shown with further aggressive amputation.
Recommendation no. 7	Counsel patients to the grim prognosis associated with acrometastasis.