A hand and wrist, showing on the hypotherar eminence an oval ulcer 4 x 2 cm. A small section has
been taken from the edge of the ulcer for diagnostic purposes. On the back of the wrist, there is an
ulcer some 6 cm. in diameter, extending deeply and eroding tendons. A biopsy for diagnostic
purposes has been taken from one edge. The surrounding skin is pale and appears thin while,
distally, the tissues are swollen; the incised wounds on the back of the hand have been made after
the amputation, for a reason which is not quite clear.
This man was first seen in July 1975 with an ulcer on the back of his right hand; he had
noticed a graze there some two years before, which did not heal. The ulcer had gone on enlarging
until his admission. The lesion was treated with radiotherapy and bleomycin. In November, further
radiation was given to this lesion and to a metastatic deposit in the skin of the right upper arm. The
primary lesion had healed, but subsequently broke down, and he was finally admitted for
amputation. Microscopically, the lesion on the back of the hand was seen to be a squamous cell
carcinoma, but the ulcer on the hypotenar eminence was, in fact, a malignant melanoma. Death
occurred some six months after amputation; there were widespread metastases present.