25584              SQUAMOUS CELL CARCINOMA OF THE SKIN

The patient was a woman aged 67.  Three years previously a small sore appeared on the dorsum of the right hand and did not enlarge for 2 years.  For the last 12 months it enlarged very rapidly.  On examination a very large ulcerating lesion was present, extending down to the dorsal tendons, with marked subcutaneous involvement spreading up the right arm to the right axilla.  Axillary glands were obviously enlarged but the supra-clavicula nodes were not enlarged.  Chest X-ray showed no abnormality.  A right forequarter amputation was performed.

The specimen consists of the right hand and forearm extending to the region of the elbow.  The hand is markedly oedematous and there is an extensively ulcerated tumour measuring 90 x 60 mms on the dorsum of the hand.  The edges are raised, irregular and nodular, and the base is ulcerated and deeply excavated.  There are numerous raised nodular and ulcerated secondary deposits, varying in size from 1 to 4 cm in diameter, on the dorsal aspect of the forearm.  Histology shows a moderately well differentiated squamous cell carcinoma with 2 pseudo-glandular pattern.  Axillary nodes were almost entirely replaced by metastatic tumour.