[Spinocellular epithelioma of the hand. Apropos of a diffuse and extensive commissural form]

The authors report a case of squamous cell carcinoma of the hand unusual because of its very rapid extension: A 64 year old man was referred to us for treatment of a keratoacanthoma located in the thumb web (histological diagnosis on two occasions). In fact, the histological frozen-section examination at the time of surgery revealed a well differentiated squamous cell carcinoma. A wide excision of the tumor was carried out together with amputation of the index finger according to Chase's technique. Axillary lymphadenectomy was performed due to clinical evidence of regional lymphatic spread (large node) twenty one days following surgery. Four months later, a recurrence in the thumb web required radiocarpal disarticulation. Three months later, a new recurrence at the stump, spreading to the forearm, necessitated an above-elbow amputation. In relation to this unusual case, the authors emphasize the importance of initial diagnosis and the difficulties of surgical management of this tumor, especially in palmar and web or deep locations.