Local recurrence after surgical management of squamous cell carcinoma of the hand: a systematic review

The internationally recommended reference-standard treatment for cutaneous squamous cell carcinoma is surgical excision. International guidelines recommend excision margins based on the risk of recurrence, which is determined by several features including the anatomical site. The lip and ear are universally recognized as high-risk sites, although there are discrepancies in the guidelines regarding the risk stratification of hand squamous cell carcinoma. This systematic review examines the evidence for the local recurrence rate of invasive squamous cell carcinoma of the hand following surgical excision.

On 4 February 2024, we searched MEDLINE, Embase, CENTRAL and ClinicalTrials.gov. A supplementary search was performed on 23 January 2025. All study types reporting recurrence data following excision of more than five primary invasive squamous cell carcinomas of the hand were included. Cases of in-situ squamous cell carcinoma were excluded.

Sixteen case series reporting 1437 lesions and 3752 lesion-years of follow-up were included. Eight studies reported no recurrences, although they lacked sufficient data or follow-up. Six studies reported high incidences of recurrence ranging from 7 to 31%. The two largest studies reported recurrence incidences of 1 and 2%, respectively. Of the included studies, only one commented on adherence to international guidelines within their results.

Owing to the heterogeneous nature of lesion types and management, as well as follow-up and potential study bias, the incidence of recurrence of squamous cell carcinoma in the hand varies in this review. The uncertainty in the evidence is reflected by discrepancies in international guidelines. Further research is needed to establish recurrence risk and inform management decisions.