RIGHT HAND - Squamous Cell Carcinoma and Malignant Melanoma

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.