An unusual lesion of the finger presenting to the emergency department

Squamous cell carcinoma (SCC) of the finger, especially those arising from the nail bed matrix and lateral skin folds are common, especially after the fifth decade of life. A variety of aetiological factors and associations have been described. The appearance can be so ambiguous and appear benign that it can lead to a delay in presentation and diagnosis.

We report a case of a 66 year old retired Engineer who presented to our Emergency Department with a 2-year history of a painless swelling of his left ring finger. Examination revealed a diffuse circumferential swelling of the left ring finger involving the middle and distal phalanx. The tip was insensate. The differential diagnoses included pyogenic granuloma, soft tissue sarcoma and chronic granulomatous infection. An excisional biopsy confirmed the diagnosis of a well differentiated squamous cell carcinoma.

This case highlights how digital squamous cell carcinoma can appear benign, mimic a wide variety of conditions leading to a delay in diagnosis and treatment. It usually runs an indolent course but can be locally destructive. Excisional biopsy, providing a clear margin where possible is usually sufficient in the absence of metastatic spread.

Chronic, non-healing lesions of the digits should be viewed with suspicion. Digital squamous cell carcinoma commonly mimics a variety of benign conditions and efforts should be made to rule out other possible diagnoses and to institute early treatment.