Squamous Cell Carcinoma on the Hand

An 87-year-old woman sought treatment of what she described as a “bite” of 1 month’s duration. The pink, nodular lesion on the dorsum of the left hand had central superficial ulceration with yellow crusting at the web space between the thumb and index finger. Dr Robert P. Blereau of Morgan City, La, suspected a keratoacanthoma because of the lesion’s rapid development. The nodule was completely excised. The pathologist reported microscopic features similar to keratoacanthoma; however, a few basal sites in the lesion appeared to be more invasive than those typically seen in the benign epithelial tumors. The lesion was diagnosed as a superficially invasive squamous cell carcinoma. Other microscopic features and solar degeneration suggested that the carcinoma arose from an actinic keratosis. A thorough search of the patient’s body revealed no other such lesions.