Carcinoma of the lung is the most common lethal form of cancer in both men and women worldwide.1 It accounts for more deaths than the next 3 most common cancers combined. In 2012, 160,000 Americans are estimated to have died from lung cancer.1 Lung cancer is known to have a high metastatic potential for the brain, bones, adrenal glands, lungs, and liver.2 Orthopedic manifestations frequently include bony metastasis, most commonly the vertebrae (42%), ribs (20%), and pelvis (18%).3 Acral metastatic disease is defined as metastasis distal to the elbow or the knee. Bony acral metastases from lung carcinoma to the upper and lower extremities are extremely uncommon, accounting for only 1% each of total bone metastases from carcinoma of the lung.3 Metastases to the bones of the hand are even rarer. Only 0.1% of metastatic disease from any type of carcinoma or sarcoma manifests as metastasis in the hand.4 There are only a few reports in the literature of soft-tissue or muscular metastasis to the hand from a carcinoma. Of these cases, the majority are caused by metastatic lung carcinoma.5-9 There are no reports in the literature of metastatic disease of squamous cell origin affecting the soft tissues of the hand.
We present a case of a man with known metastatic squamous cell carcinoma of the lung who presented with acral soft-tissue metastatic disease. This report highlights a rare clinical scenario that has not been reported in the literature. The report also emphasizes a rare but important consideration for clinicians who encounter acral soft-tissue lesions in patients with a history of a primary carcinoma. The patient provided written informed consent for print and electronic publication of this case report.
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