Subject(s)
Hand Dermatoses/therapy , Lymphangitis/therapy , Nocardia Infections/therapy , Thumb/microbiology , Aged , Anti-Bacterial Agents/therapeutic use , Cactaceae , Combined Modality Therapy , Debridement , Drainage , Female , Hand Dermatoses/microbiology , Humans , Nocardia Infections/microbiology , Reoperation , Therapeutic Irrigation , Thumb/injuries , Wounds, StabABSTRACT
BACKGROUND: Verrucous carcinoma is a well-differentiated variant of squamous cell carcinoma seen on mucosa and skin, including the hands. METHODS: We report the case of a large verrucous carcinoma of the right palm which was completely resected with a fourth ray resection and remained without evidence of tumor recurrence or metastatic disease during follow-up for 11 years. On this basis, we reviewed all 15 previously published cases of verrucous carcinoma of the hand to define the peculiarities of this uncommon tumor and to give diagnostic and therapeutic recommendations. RESULTS: Verrucous carcinoma is defined by its characteristic clinical presentation as slowly but relentlessly enlarging "wart-like" tumor, by the typical histologic finding of local invasion with only minimal, if any, dysplasia and by the unique biological behavior with low incidence of metastases and good prognosis. For proper diagnosis, both careful physical examination and deep surgical biopsy must be performed. Radical resection is the treatment of choice with histologically confirmed tumor-free resection margins. Lymphadenectomy should only be performed in case of suspicious lymphadenopathy. CONCLUSIONS: Verrucous carcinoma may present a difficult diagnostic problem. After complete surgical resection, it has a good prognosis.
