Mateusz Gładysz FESSH prep

FESSH prep Hand tumours Squamous cell carcinoma, subungual melanoma (Hutchinson sign, amputation level), chondrosarcoma, epithelioid sarcoma

Malignant tumours of the hand

Last reviewed v1.0

FESSH-056Hand tumours●●● advanced

Regarding malignant tumours of the hand:

  1. 1.Squamous cell carcinoma is the most common malignant tumour of the hand.

  2. 2.Hutchinson sign is pathognomonic of subungual melanoma and is not seen in benign longitudinal melanonychia.

  3. 3.In subungual melanoma of the thumb, amputation at a more proximal level improves survival compared with amputation through the interphalangeal joint, once clear margins are obtained.

  4. 4.Chondrosarcoma is the most common primary malignant bone tumour of the hand.

  5. 5.Epithelioid sarcoma typically arises in the distal extremities of young adults, and the lymph nodes are its most common initial site of metastasis.

FESSH marking: +1 per correct statement, 0 for blank, −1 for incorrect. Click the same TRUE/FALSE button twice to clear it.

Question ID
FESSH-056
First published
Last reviewed
Version
v1.0
Answer key and explanations — open after answering

  1. 1. Squamous cell carcinoma is the most common malignant tumour of the hand.

    True

    Skin cancers are the most common primary malignancies of the hand, and squamous cell carcinoma predominates, followed by basal cell carcinoma and melanoma. In Maciburko's series of 541 cutaneous malignancies of the hand squamous cell carcinoma made up 78.0%, basal cell carcinoma 11.3% and melanoma 3.9%.

    • Ilyas EN, Leinberry CF, Ilyas AM. Skin cancers of the hand and upper extremity. J Hand Surg Am. 2012;37(1):171-8. PMID 22196297
    • Maciburko SJ, Townley WA, Hollowood K, Giele HP. Skin cancers of the hand: a series of 541 malignancies. Plast Reconstr Surg. 2012;129(6):1329-1336. PMID 22327895

  2. 2. Hutchinson sign is pathognomonic of subungual melanoma and is not seen in benign longitudinal melanonychia.

    False

    Hutchinson sign, extension of pigment onto the proximal or lateral nail fold, is the 'E' of Levit's ABCDEF rule and a strong indicator of subungual melanoma. In Bang's series it was present in 82.9% of subungual melanomas, but pseudo-Hutchinson pigmentation was seen in 44.8% of benign longitudinal melanonychia, so the sign is not pathognomonic.

    • Bang JS, Kim JY. Clinical differences between Hutchinson's sign in subungual melanoma and pseudo-Hutchinson's sign in benign longitudinal melanonychia. J Am Acad Dermatol. 2025;94(2):478-484. PMID 41396573
    • Levit EK, Kagen MH, Scher RK, Grossman M, Altman E. The ABC rule for clinical detection of subungual melanoma. J Am Acad Dermatol. 2000;42(2 Pt 1):269-74. PMID 10642684

  3. 3. In subungual melanoma of the thumb, amputation at a more proximal level improves survival compared with amputation through the interphalangeal joint, once clear margins are obtained.

    False

    In the Mayo Clinic series of 124 patients, analysis of the 116 who underwent amputation, adjusted for tumour depth and clinical involvement, showed that level of resection was not significantly associated with progression-free, overall or disease-specific survival. Heaton likewise found that the level of amputation did not affect survival or local recurrence, and Moehrle found that patients amputated in or proximal to the distal interphalangeal joint did not fare better than those treated by less radical functional surgery.

    • Nguyen JT, Bakri K, Nguyen EC, Johnson CH, Moran SL. Surgical management of subungual melanoma: mayo clinic experience of 124 cases. Ann Plast Surg. 2013;71(4):346-54. PMID 24025653
    • Heaton KM, el-Naggar A, Ensign LG, Ross MI, Balch CM. Surgical management and prognostic factors in patients with subungual melanoma. Ann Surg. 1994;219(2):197-204. PMID 8129491
    • Moehrle M, Metzger S, Schippert W, Garbe C, Rassner G, Breuninger H. "Functional" surgery in subungual melanoma. Dermatol Surg. 2003;29(4):366-74. PMID 12656815

  4. 4. Chondrosarcoma is the most common primary malignant bone tumour of the hand.

    True

    In a SEER analysis of 315 primary malignant bone tumours of the hand, chondrosarcoma accounted for 52.06%, followed by osteosarcoma, giant cell tumour and Ewing sarcoma. Hand chondrosarcoma behaves as a locally aggressive lesion but rarely metastasises.

    • Alves AS, Fabi A, Oranges CM. Epidemiological Analysis of Malignant Bone and Cartilage Tumors in the Hand With Focus on Chondrosarcoma: A Twenty-year Study with a Focus on Surgical Treatment Outcomes. Anticancer Res. 2025;45(10):4535-4546. PMID 41006001
    • García-Jiménez A, Chanes-Puiggrós C, Trullols-Tarragó L, Pulido-García MC. Chondrosarcoma of the Hand Bones: A Report of 6 Cases and Review of the Literature. J Hand Surg Asian Pac Vol. 2019;24(1):45-49. PMID 30760143

  5. 5. Epithelioid sarcoma typically arises in the distal extremities of young adults, and the lymph nodes are its most common initial site of metastasis.

    True

    Chase and Enzinger's review of 241 cases confirmed the predilection for the distal extremities of young adults; the most common initial sites of metastasis were lymph nodes (48%) and lungs (25%). In a systematic review of hand soft-tissue sarcomas it was the most common histology (27%).

    • Chase DR, Enzinger FM. Epithelioid sarcoma. Diagnosis, prognostic indicators, and treatment. Am J Surg Pathol. 1985;9(4):241-63. PMID 4014539
    • Calmet Rocca WR, Kuthiala RS, Gonzalez MR, Pretell-Mazzini J. Evaluation of Treatment Modalities and Oncologic Outcomes in Hand Soft Tissue Sarcomas-A Systematic Review of the Literature. Cancers (Basel). 2025;17(19). PMID 41097731