Digital acrometastasis: a rare initial sign of occult pulmonary squamous cell carcinoma

Digital metastases as the initial presenting sign of an occult pulmonary squamous cell carcinoma are very rare. While many tumours do progress to involve the digits in advanced stages, diagnosis of underlying lung cancer based on the initial presentation of a digital mass is very unusual. Clinically, metastasis to the phalanges typically results in notable tenderness, swelling, warmth and dull, throbbing pain. While nail avulsion with curettage and local tumour excision has been used in attempts to save the digit, amputation of the involved finger is by far the most frequent surgical methodology. Unfortunately, by this time, the primary tumour has invariably spread to diffusely involve other organs, and survival periods average only a few months. Management should be targeted to patient comfort, prevention of infection, and maintenance of function. (C) 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.