Skin Cancer of the Hand

Figure 1. Squamous cell carcinoma with a small cutaneous horn.
Figure 1. Squamous cell carcinoma with a small cutaneous horn.
Figure 2. Squamous cell carcinoma may look like a cut or infection that does not heal, including in the nail bed.
Figure 2. Squamous cell carcinoma may look like a cut or infection that does not heal, including in the nail bed.

Cancer of the skin is a change in skin cells that causes them to grow abnormally. As these cells become more abnormal, they may damage local tissue through rapid growth and invasion. Aggressive skin cells can form a malignant tumor, meaning abnormal cells can spread through the body, invade organs, and grow in new areas.

The skin is the largest organ by surface area, and it is the most common part of the body in which cancer develops. Squamous cell carcinoma is the most common type of skin cancer of the hand. Basal cell carcinoma is next most common, and melanoma is also a common skin cancer. Melanoma is the most dangerous type because it can spread and may result in death if not recognized and treated early.

Causes

Squamous cell carcinoma, basal cell carcinoma, and melanoma are all associated with chronic sun exposure. Some people are at higher risk, including people who burn easily or have light or fair skin. Patients with immune suppression from other disorders or medications may also be at higher risk.

Other factors that can increase the risk of skin cancer include exposure to radiation or certain chemicals such as arsenic. Certain genetic conditions, such as xeroderma pigmentosum and Gorlin syndrome, can also increase risk.

Melanoma may be more likely in people with:

  • Actinic keratosis, which are scaly or crusty growths
  • Cutaneous horns, which are cone-like bumps on the skin
  • Bowen's disease
  • Certain family history
  • Certain types of moles

Signs and Symptoms

Squamous cell carcinoma

This type of skin cancer may look like small, firm nodules on the skin. They are often brown or tan and may cause scales, ulcers, bleeding, or crusting. The scaly, crusty top layer can build up and create a cutaneous horn. Some people may mistakenly think the cancer is a cut or infection that will not heal. For some, squamous cell carcinoma results in large, mushroom-like growths. This type of cancer has a high potential to spread, especially to lymph nodes.

Basal cell carcinoma

This type of skin cancer can form small, well-defined nodules with a translucent, pearly border. These lesions may ulcerate and look like a chronic sore. They tend to grow more slowly and are less likely to spread.

Melanoma

Melanoma often looks like a mole or birthmark. The ABCDEs of melanoma can be warning signs:

  • A - Asymmetry: the shape is irregular.
  • B - Border: the border is irregular.
  • C - Color: there are varied colors or shades.
  • D - Diameter: the area is greater than 6 mm, or 1/4 inch.
  • E - Evolving: the lesion is changing in any way.

How Skin Cancer Is Diagnosed

Diagnosis starts with asking your doctor to inspect your skin. A careful history and physical examination will be performed. If a skin lesion has concerning features, your surgeon may suggest taking a tissue sample called a biopsy.

Some biopsies remove only part of a larger mass to define the lump; this is called an incisional biopsy. When the entire mass is removed, it is called an excisional biopsy. Depending on the tumor type, size, and location, a wider margin of normal tissue may be needed. A detailed pathology report can help guide treatment.

The lymph nodes should also be examined, especially with melanoma and squamous cell carcinoma. Sometimes lymph nodes may need to be removed to determine if the cancer has spread. Additional imaging such as a CT scan and/or PET scan may be needed, especially with melanoma.

Treatment

The standard treatment for skin cancer is surgical removal. The amount of tissue removed around the mass depends on the tumor type, depth, and other factors. Small wounds may heal without stitches, while larger wounds may need closure, local tissue rearrangement flaps, or skin grafting.

Advanced malignant skin cancers may require amputation to obtain local control, prevent spread, and decrease the chance of dying from the cancer. Additional treatment such as radiation and/or chemotherapy may also be needed.

Prevention

  • Wear protective clothing and sunscreen in the sun.
  • Limit sun exposure when possible, including exposure through windows.
  • Avoid high-risk chemicals such as arsenic.
  • Check your skin regularly. New lumps or changes in old lumps or moles should be evaluated by a doctor or health care provider.

This mobile-friendly version is adapted from patient education content originally provided by the American Society for Surgery of the Hand.