Cancer can affect the hand, wrist, and fingers. Although most lumps and bumps in this area are non-cancerous, primary malignancies can originate in the hand’s complex anatomical structures, including the skin, soft tissues, and bone. Hand cancer is rare compared to cancers in other parts of the body, but it encompasses various tumor types requiring specialized knowledge for diagnosis and treatment. Prompt identification and effective management begin with understanding the potential for malignant growth in this intricate extremity.
Defining Malignancies of the Hand
“Hand cancer” is an umbrella term for any malignant growth originating within the anatomical structures of the hand, including the wrist and fingers. The hand is composed of numerous tissue types, such as skin, tendons, nerves, vessels, and 27 bones. Due to this complexity, the term refers to cancers arising from skin cells, connective tissues, cartilage, or bone, rather than a single disease.
Malignant tumors starting in the hand are uncommon compared to benign lesions, such as ganglion cysts. The vast majority of masses found in the hand are benign. However, the visibility and high functional use of the hand often lead to early recognition of abnormal growth, which can positively affect the outcome of a malignant diagnosis. Malignancies in the hand can also be metastatic, meaning the cancer has spread from a primary site elsewhere in the body, such as the lung or breast.
Common Types of Hand Cancer
Skin cancers are the most frequent malignancies found in the hand. Squamous Cell Carcinoma (SCC) is the most common type of primary hand cancer, often appearing on the dorsum of the hand due to chronic sun exposure. SCC originates in the flat cells of the outer skin layer and has the potential to spread to the lymph nodes. Basal Cell Carcinoma (BCC) is the second most common skin malignancy; it is generally slower-growing and rarely spreads to distant sites.
Melanoma is the most dangerous skin cancer type in the hand due to its high potential for metastasis. It arises from pigment-producing cells and can appear as a new lesion, a change in an existing mole, or sometimes as a dark stripe underneath the fingernail.
Beyond skin cancers, malignancies can arise from soft tissues or bone. Soft tissue sarcomas are less common and originate in connective tissues like fat, muscle, or tendon sheaths. Examples include epithelioid sarcoma and synovial sarcoma, which are generally deep-seated and slow-growing. Primary bone tumors are the rarest category. Chondrosarcoma, a cancer of the cartilage-forming cells, often affects the small bones of the fingers. Osteosarcoma, which develops in the bone tissue itself, is an extremely rare malignant bone tumor in the hand.
Identifying Warning Signs and Diagnostic Procedures
Identifying warning signs depends on the tissue of origin, but any persistent or unusual change in the hand requires medical evaluation. For skin cancers, look for a non-healing sore or persistent ulcer that might resemble a cut or infection. Other concerning skin changes include scaly patches, firm nodules that may bleed or crust, or any mole that is growing, changing color, or has an irregular border.
Melanoma lesions are often suspicious if they display the ABCDE characteristics:
- Asymmetry
- Irregular Borders
- Multiple Colors
- Large Diameter
- Evolution or change over time
Signs of soft tissue or bone malignancies typically involve a new lump or mass that may initially be painless. As the tumor grows, symptoms may progress to localized pain not connected to an injury, increasing joint stiffness, or swelling. A tumor growing within the bone might cause deep, persistent bone pain and a gradual bulging of the area.
The diagnostic process begins with a thorough physical examination and medical history review by a specialist. Imaging studies are a subsequent step; X-rays evaluate bone involvement, while Magnetic Resonance Imaging (MRI) or ultrasound define the size and nature of a soft tissue mass. Confirmation of malignancy requires a biopsy, where a small sample of the suspicious tissue is removed and analyzed by a pathologist to determine the specific type and aggressiveness of the cancer cells.
Treatment Modalities
Treatment for hand cancer depends on the tumor type, its stage, and its location within the hand’s anatomy. Surgery is the most common method, focusing on complete removal of the malignant tissue while preserving hand function. For skin cancers, specialized techniques like Mohs surgery remove the tumor layer by layer, ensuring clear margins while minimizing the removal of healthy tissue.
Excision of soft tissue or bone tumors requires careful planning to account for the proximity of nerves, tendons, and joints. Reconstructive surgery, involving skin grafts or local flaps, is often necessary due to potential tissue loss. Radiation therapy may be used with surgery, either before to shrink a large tumor or afterward to eliminate remaining microscopic cancer cells.
Radiation may be used as the primary treatment when surgery is not an option for certain cancers, such as advanced skin cancers or sarcomas. Systemic therapies, which treat the entire body, include chemotherapy and immunotherapy. Chemotherapy uses medications to kill or slow the growth of rapidly dividing cancer cells. Immunotherapy harnesses the body’s own immune system to recognize and attack cancer cells. These treatments are typically reserved for aggressive cancers, such as melanoma or high-grade sarcomas, or when the disease has spread beyond the hand.