The internationally recommended reference-standard treatment for cutaneous squamous cell carcinoma is surgical excision. International guidelines recommend excision margins based on the risk of recurrence, which is determined by several features including the anatomical site. The lip and ear are universally recognized as high-risk sites, although there are discrepancies in the guidelines regarding the risk stratification of hand squamous cell carcinoma. This systematic review examines the evidence for the local recurrence rate of invasive squamous cell carcinoma of the hand following surgical excision.
Methods:
On 4 February 2024, we searched MEDLINE, Embase, CENTRAL and ClinicalTrials.gov. A supplementary search was performed on 23 January 2025. All study types reporting recurrence data following excision of more than five primary invasive squamous cell carcinomas of the hand were included. Cases of in-situ squamous cell carcinoma were excluded.
Results:
Sixteen case series reporting 1437 lesions and 3752 lesion-years of follow-up were included. Eight studies reported no recurrences, although they lacked sufficient data or follow-up. Six studies reported high incidences of recurrence ranging from 7 to 31%. The two largest studies reported recurrence incidences of 1 and 2%, respectively. Of the included studies, only one commented on adherence to international guidelines within their results.
Conclusion:
Owing to the heterogeneous nature of lesion types and management, as well as follow-up and potential study bias, the incidence of recurrence of squamous cell carcinoma in the hand varies in this review. The uncertainty in the evidence is reflected by discrepancies in international guidelines. Further research is needed to establish recurrence risk and inform management decisions.
AlamMCaldwellJBEliezriYD.Human papillomavirus-associated digital squamous cell carcinoma: literature review and report of 21 new cases. J Am Acad Dermatol. 2003, 48: 385–93.
2.
AleissaSCowenENavarrete-DechentC, et al. Squamous cell carcinoma in situ upstaging is not frequent in the nail unit: a tertiary cancer center experience. Arch Dermatol Res. 2022, 314: 89–93.
3.
AlghamdiIRobertNRevolM.Fingertips squamous cell carcinoma: treatment outcomes with surgical excision and full thickness skin graft. Ann Chir Plast Esthet. 2016, 61: 39–43.
4.
AskariMKakarSMoranSL.Squamous cell carcinoma of the hand: a 20-year review. J Hand Surg Am. 2013, 38: 2124–33.
BilimoriaKYPhillipsJDRockCEHaymanAPrystowskyJBBentremDJ.Effect of surgeon training, specialization, and experience on outcomes for cancer surgery: a systematic review of the literature. Ann Surg Oncol. 2009, 16: 1799–808.
7.
Centre for Reviews and Dissemination University of York. Prospero international prospective register of systematic reviews, 2021. https://www.crd.york.ac.uk/prospero/ (accessed 30 January 2025).
8.
ChakrabartiIWatsonJDDorranceH.Skin tumours of the hand: a 10 year review. J Hand Surg Br. 1993, 18: 484–6.
9.
Cuellar-BarbozaAGonzalezAGerleroP.43447 squamous cell carcinoma of the nail unit treated with Mohs surgery: a retrospective study in a Latin American population. J Am Acad Dermatol. 2023, 89: AB225.
10.
DalleSDepapeLPhanABalmeBRonger-SavleSThomasL.Squamous cell carcinoma of the nail apparatus: clinicopathological study of 35 cases. Br J Dermatol. 2007, 156: 871–4.
11.
De BerkerDARDahlMGCMalcolmAJLawrenceCM.Micrographic surgery for subungual squamous cell carcinoma. Br J Plast Surg. 1996, 49: 414–9.
12.
DikaEPiracciniBMBalestriR, et al. Mohs surgery for squamous cell carcinoma of the nail: report of 15 cases. Our experience and a long-term follow-up. Br J Dermatol. 2012, 167: 1310–4.
13.
FigusAKanitkarSElliotD.Squamous cell carcinoma of the lateral nail fold. J Hand Surg. 2006, 31: 216–20.
14.
GouDNijhawanRISrivastavaD.Mohs micrographic surgery as the standard of care for nail unit squamous cell carcinoma. Dermatol Surg. 2020, 46: 725–32.
15.
GuitartJBergfeldWTuthillRTubbsRZienowiczRFleeglerE.Squamous cell carcinoma of the nail bed: a clinicopathological study of 12 cases. Br J Dermatol. 1990, 123: 215–22.
16.
GuyattGOxmanAVistG, et al. Grade: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ (Clin Res Ed). 2008, 336: 924–6.
17.
HaddawayNRPageMJPritchardCCMcGuinnessLA.Prisma2020: an R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and open synthesis. Campbell Syst Rev. 2022, 18: e1230.
18.
HiranputSYesudianPDBalasubramaniamP.50546 secondary intention healing of surgical wounds in the dorsal hand: an under-utilized technique?J Am Acad Dermatol. 2024, 91: AB84.
19.
IrmakFSirvanSSSerinMSevimKZYesiladaAKYazarSK. Squamous cell carcinoma of the hand: clinical presentation, surgical treatment, outcome and survival rate: a series of 129 cases. Turk Dermatoloji Dergisi. 2019, 13: 30–4.
20.
KeohaneSBottingJBudnyP, et al. British association of dermatologists guidelines for the management of people with cutaneous squamous cell carcinoma 2020. Br J Dermatol. 2021, 184: 401–14.
21.
KhanKMykulaRKersteinR, et al. A 5-year follow-up study of 633 cutaneous scc excisions: rates of local recurrence and lymph node metastasis. J Plast Reconstr Aesthet Surg. 2018, 71: 1153–8.
22.
KimJKoHKimBKimMBKimH.50842 mohs micrographic surgery for nail-unit squamous cell carcinoma. J Am Acad Dermatol. 2024, 91: AB258.
23.
LecerfPRichertBTheunisAAndreJ.A retrospective study of squamous cell carcinoma of the nail unit diagnosed in a Belgian general hospital over a 15-year period. J Am Acad Dermatol. 2013, 69: 253–61.
24.
LeeJSMunJH.Preoperative and intraoperative dermoscopy of nail unit squamous cell carcinoma and its relationship with the depth of invasion: a retrospective study. J Am Acad Dermatol. 2024, 91: 522–4.
25.
LeeT-MJoGKimM, et al. Squamous cell carcinoma of the nail unit: a retrospective review of 19 cases in Asia and comparative review of western literature. Int J Dermatol. 2019, 58: 428–32.
26.
LiuCLiuXCaoPLiXXinHZhuS. Global, regional, national prevalence, mortality, and disability-adjusted life-years of cutaneous squamous cell carcinoma and trend analysis from 1990 to 2021 and prediction to 2045. Front Oncol. 2025, 15: 1523169.
27.
MaciburkoSJTownleyWAHollowoodKGieleHP.Skin cancers of the hand: a series of 541 malignancies. Plast Reconstr Surg. 2012, 129: 1329–36.
28.
Marti-MartiIBosch-AmateXMorgado-CarrascoD, et al. High-risk mucosal human papillomavirus-associated squamous cell carcinoma of the fingers presents distinctive clinicopathological characteristics and outcomes: a bicentric retrospective study. Clin Exp Dermatol. 2023, 48: 211–7.
29.
McGuinnessLAHigginsJPT. Risk-of-bias visualization (ROBVIS): an R package and Shiny web app for visualizing risk-of-bias assessments. Res Synth Methods. 2021, 12: 55–61.
30.
MesaFLealORamosME.Brunelli (dorsoulnar) flap for the reconstruction of defect of the thumb nail unit after oncological resections with Mohs micrographic surgery. Plast Reconstr Surg Glob Open. 2024, 12: e6401.
31.
MotleyRKerseyPLawrenceC.Multiprofessional guidelines for the management of the patient with primary cutaneous squamous cell carcinoma. Br J Dermatol. 2002, 146: 18–25.
32.
MotleyRKerseyPLawrenceC.Multiprofessional guidelines for the management of the patient with primary cutaneous squamous cell carcinoma. Br J Plast Surg. 2003, 56: 85–91.
33.
MullJLPhelanPSMullABRussellAJHurstEACouncilML.Squamous cell carcinoma of the hand: a retrospective study in immunosuppressed and immunocompetent individuals. Dermatol Surg. 2020, 46: 1014–20.
34.
MunnZBarkerTMoolaS, et al. Methodological quality of case series studies: an introduction to the JBI critical appraisal tool. JBI Evid Synth. 2020, 18(10):2127–33.
NelsonTAshtonR.Low incidence of metastasis and recurrence from cutaneous squamous cell carcinoma found in a UK population: do we need to adjust our thinking on this rare but potentially fatal event?J Surg Oncol. 2017, 116: 783–8.
37.
NolanGSDunneJALeeAE, et al. National audit of non-melanoma skin cancer excisions performed by plastic surgery in the UK. Br J Surg. 2022, 109: 1040–3.
38.
OrmerodEde BerkerD.Nail unit squamous cell carcinoma in people with immunosuppression. Br J Dermatol. 2015, 173: 701–12.
39.
OuzzaniMHammadyHFedorowiczZElmagarmidA.Rayyan – a web and mobile app for systematic reviews. Syst Rev. 2016, 5: 1–10.
40.
PageMMcKenzieJBossuytP, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ (Clin Res Ed). 2021, 372: n71.
41.
RaynerCR. The results of treatment of two hundred and seventy-three carcinomas of the hand. Hand. 1981;13(2):183-6. doi:10.1016/s0072-968x(81)80061-7
42.
RimlSLarcherLKompatscherP.Complete excision of nonmelanotic skin cancer: a matter of surgical experience. Ann Plast Surg. 2013, 70: 66–9.
43.
RoweDCarrollRDayC.Prognostic factors for local recurrence, metastasis, and survival rates in squamous cell carcinoma of the skin, ear, and lip. Implications for treatment modality selection. J Am Acad Dermatol. 1992, 26: 976–90.
44.
SayedLDeodharAKAgarwalR.A single centre experience of squamous cell carcinoma of the upper limb requiring digital or hand amputation and review of literature. JPRAS Open. 2019, 20: 43–58.
45.
SchiavonMMazzoleniFChiarelliAMatanoP.Squamous cell carcinoma of the hand: fifty-five case reports. J Hand Surg Am. 1988, 13: 401–4.
46.
ShapiroLBarafC.Subungual epidermoid carcinoma and keratoacanthoma. Cancer. 1970, 25: 141–52.
47.
StratigosAGarbeCDessiniotiC, et al. European consensus-based interdisciplinary guideline for invasive cutaneous squamous cell carcinoma: part 2. Treatment-update 2023. Eur J Cancer (Oxford, England: 1990). 2023, 193: 113252.
48.
TangNMaloneyMEClarkAHJellinekNJ.A retrospective study of nail squamous cell carcinoma at 2 institutions. Dermatol Surg. 2016, 42: S8–S17.
49.
TerKondaSPerdikisG.Non-melanotic skin tumors of the upper extremity. Hand Clin. 2004, 20: 293–301.
50.
ThompsonAKKelleyBFProkopLJMuradMHBaumCL.Risk factors for cutaneous squamous cell carcinoma recurrence, metastasis, and disease-specific death: a systematic review and meta-analysis. JAMA Dermatol. 2016, 152: 419–28.
51.
TripoliMFranzaMCordovaA.An overview and our approach in the treatment of malignant cutaneous tumours of the hand. Acta Cir Plast. 2020, 62: 4–9.
52.
Work Group, Invited Reviewers,KimJYS, et al. Guidelines of care for the management of cutaneous squamous cell carcinoma. J Am Acad Dermatol. 2018, 78: 560–78.
53.
YoungLCTuxenAJGoodmanG.Mohs’ micrographic surgery as treatment for squamous dysplasia of the nail unit. Australas J Dermatol. 2012, 53: 123–7.
54.
ZabawskiEWashakRCohenJCockerellCBrownS.Squamous cell carcinoma of the nail bed: is finger predominance another clue to etiology? A report of 5 cases. Cutis. 2001, 67: 59–64.
55.
ZakhemGAPulavartyANCarucciJStevensonML.Association of patient risk factors, tumor characteristics, and treatment modality with poor outcomes in primary cutaneous squamous cell carcinoma: a systematic review and meta-analysis. JAMA Dermatol. 2023, 159: 160–71.
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