[Cancer metastases of the hand]

The distribution of metastases in the skeleton corresponds to the presence of active hemato-poetic bone marrow. Osseous metastases distal to the elbow and knee joints are therefore rare. 67 patients with metastatic tumors of the hand were analyzed in a bibliographical review and two cases are added. A hypernephroid carcinoma and a bronchogenic carcinoma had both metastasized to the distal phalanx of the thumb and had simulated a whitlow in both cases. The distal phalanx is the most common site of metastases. The most frequent primary lesions are, in order, lung, kidney and breast. Not only clinically but also radiologically and peripheral bone metastasis can be taken for a whitlow. In most cases the X-ray shows a lytic lesion, often ruptured into the soft tissues. Benign and malignant neoplasms must be considered in the differential diagnosis of such lytic lesions, but mostly they are metastatis. X-ray and chemo therapy in this situation may at least reduce pain otherwise exstirpation of the appropriate fingers or part of the hand is indicated. As a rule survival is short.