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Non-Melanoma Skin and Soft-Tissue Tumors of the Upper Limb: Epidemiological Casuistry, Surgical Treatment and Mid-Long Term Outcome
Ivan Couto-González, MD; Beatriz Brea-García, MD; Antonio Taboada-Suárez, MD, PhD
Plastic and Reconstructive Surgery, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain

Introduction: Malignant non-melanoma tumors (MNMT) of the soft tissue of the upper limbs do not present higher mortality rates than melanoma but they can be a cause of considerable morbidity, especially in advanced clinical stages.

Material & Methods: We planned an observational retrospective study reviewing the clinical records of patients diagnosed with soft-tissue MNMT in the upper limbs in our department from 2007 to 2009. The aim of this review was to determine the epidemiological and clinical characteristics of the tumors diagnosed, as well as the effectiveness of the treatment received and its outcome until December 2012.

Results: Fifty-eight patients were included in the study. Male-female ratio was 1:1. The average age at diagnosis was 76.70 years old (min.:38, max.:94). Forty-four cases were squamous cell carcinoma (SCC)(75.9%), 9 cases were basal cell carcinoma (BCC)(15.5%), 4 cases were classified as sarcomas (6.9%) and only 1 case was diagnosed as a Merkel’s cell carcinoma. Histological differentiation was classified as G-1 in most of the cases. Synchronic tumors were observed in 8.6% of the patients, mainly in the cases with SCC. Metastatic disease in axillary lymph nodes were found (with histological confirmation) in 12.07% of the cases (Table-1). The general mortality rate was 13.79% with a mean follow-up of 47.84 months (min.: 36, max.: 71), but this rate is strongly related with the type of tumor and the presence of metastatic disease (Table-2).

Conclusions: Soft-tissue MNMT of the upper limbs are relatively frequent in patients of an advanced age. In the majority of cases, these were well-differentiated SCC or CBC neoplasms that could be resolved by a simple surgical removal. In the case of SCC, especially in those of a larger size or with moderately or poorly-differentiated histology, a complete examination of the axillary region is necessary in order to rule out metastatic spread (including sentinel lymph node biopsy if indicated). In the patients diagnosed with sarcoma, Merkel’s cell carcinoma or poorly-differentiated SCC, morbidity and mortality rates were dramatically increased.

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