Abstract
Mohs micrographic surgery is the best therapeutical option for hand squamous cell carcinoma without bone involvement; however, the reconstruction of the surgical defect could be very difficult if the tumour is located in the distal phalanx of a finger. We present the case of a patient with a squamous cell carcinoma of the distal phalanx of a finger, which was treated with Mohs micrographic surgery, and its surgical defect was successfully resolved by secondary‐intention healing using hydrocolloid dressings.
Keywords: hydrocolloid dressings, Mohs surgery, secondary‐intention healing, skin cancer, squamous cell carcinoma
1. INTRODUCTION
Squamous cell carcinoma (SCC) is a malignant neoplasm that is rarely localised in the finger, and an amputation may be necessary for its treatment.1 Mohs micrographic surgery (MMS) has been proposed as the best therapeutical option when there is no bone compromise because it allows the preservation of healthy tissue and increases the chances of success.2 After removing the tumour, the surgical defect could be resolved by flaps or grafts; however, sometimes these options are not convenient, and the secondary‐intention method could be the best option.3, 4
2. CASE REPORT
A 49‐year‐old man who had a kidney transplant and immunosuppressive treatment for 2 years presented for a consultation to our hospital for a tumour located in the distal phalanx of the third finger on the left hand of 1‐year evolution (Figure 1). An incisional biopsy was performed confirming the diagnosis of SCC. A hand X‐ray was performed showing no bone involvement. MMS with six phases of resection was performed, generating a deep and extensive surgical defect, with bony exposure of the distal finger phalanx (Figure 2). A decision was made to repair the defect by secondary‐intention healing, supported with hydrocolloid dressings. After 1 month, the patient presented an important anatomical restitution of the surgical defect (Figure 3).
Figure 1.
Squamous cell carcinoma of the distal phalanx of the third finger of the left hand [Colour figure can be viewed at wileyonlinelibrary.com]
Figure 2.
Deep surgical defect with bony exposure of the distal finger phalanx after Mohs surgery [Colour figure can be viewed at wileyonlinelibrary.com]
Figure 3.
Almost complete anatomical restitution of the surgical defect after 1 month [Colour figure can be viewed at wileyonlinelibrary.com]
3. DISCUSSION
A hand finger SCC can represent a great therapeutical challenge for any surgeon because the tumour must be eradicated and the functionality of the finger must be preserved simultaneously.2 Therefore, MMS should be considered the ideal therapeutical method for such a location. In cases of a large surgical defect in the distal phalanx of a finger, cutaneous flaps or grafts could be very complex, and secondary‐intention healing appears as an interesting alternative.3 In addition, the use of hydrocolloid dressings would favour adequate healing and lead to a better aesthetic result.5
4. CONCLUSIONS
After MMS for a hand SCC located in the distal phalanx of a finger, a large and deep surgical defect could be generated, and closure by secondary‐intention healing using hydrocolloid dressings results in an interesting alternative for its resolution.
Magliano J, Rossi V, Turra N, Bazzano C. Secondary‐intention healing following Mohs micrographic surgery for squamous cell carcinoma of a finger. Int Wound J. 2019;16:860–861. 10.1111/iwj.12979
REFERENCES
- 1. Alghamdi I, Robert N, Revol M. Fingertips squamous cell carcinoma: treatment outcomes with surgical excision and full thickness skin graft. Ann Chir Plast Esthet. 2016;61(1):39‐43. [DOI] [PubMed] [Google Scholar]
- 2. Dika E, Fanti PA, Patrizi A, Misciali C, Vaccari S, Piraccini BM. Mohs surgery for squamous cell carcinoma of the nail unit. Dermatol Surg. 2015;41(9):1015‐1019. [DOI] [PubMed] [Google Scholar]
- 3. Bosley R, Leithauser L, Turner M, Gloster HM. The efficacy of second‐intention healing in the management of defects on the dorsal surface of the hands and fingers after Mohs micrographic surgery. Dermatol Surg. 2012;38(4):647‐653. [DOI] [PubMed] [Google Scholar]
- 4. Sinha A, Langtry JAA. Secondary intention healing following mohs micrographic surgery for basal cell carcinoma of the nipple and areola. Acta Derm Venereol. 2011;91(1):78‐79. [DOI] [PubMed] [Google Scholar]
- 5. Bazzano C, Alvarez M, Martínez M. Apósitos hidrocoloidales en la cicatrización por segunda intención de heridas quirúrgicas. Rev Med Urug. 2008;24:32‐36. [Google Scholar]