Cutaneous Squamous Cell Carcinoma of the Hand Treated With Excision and Local Flap Reconstruction: A Two-Case Series

Abstract

Cutaneous squamous cell carcinoma of the hand presents a distinct surgical challenge because oncologic excision must be balanced against preservation of hand contour, mobility, and durable soft tissue coverage. We present two cases of cutaneous squamous cell carcinoma involving different regions of the right hand in elderly male patients. The first patient was a 78-year-old man with a progressively enlarging exophytic painful lesion on the dorsoradial aspect of the hand, treated by circumferential excision with partial fascial resection and reconstruction using multiple local transposition flaps arranged in a Z plasty type configuration. The second patient was an 82-year-old man with a painless exophytic lesion on the dorsoulnar aspect of the hand, treated by circumferential excision including the underlying subcutaneous tissue and hypothenar fascia, followed by reconstruction with a proximally based local rotational flap. In both patients, no local recurrence was detected till 6 months follow up. These cases highlight the need to integrate oncologic and reconstructive principles in the treatment of hand malignancies and show how different local flap strategies can be tailored to lesion location and defect geometry in functionally demanding regions of the hand.