Atypical Pyoderma Gangrenosum of the Dorsal Hand Mimicking Squamous Cell Carcinoma

• Published in: The Journal of hand surgery (American ed.) Vol. 37; no. 9; pp. 1835 - 1838
• Main Authors: Wolfe, Christopher M., BS, Green, W. Harris, MD, Cognetta, Armand B., MD, Baniahmad, Omid, BS, Hatfield, H. Keith, MA
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-09-2012; Elsevier
• Subjects: Aged; Amputation; Anti-Infective Agents - administration & dosage; Anti-Inflammatory Agents - administration & dosage; atypical pyoderma gangrenosum; Biological and medical sciences; Biopsy; Carcinoma, Squamous Cell - diagnosis; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - surgery; Cooperative Behavior; Dapsone - administration & dosage; Dermatology; Diagnosis, Differential; Diseases of the osteoarticular system; Drug Therapy, Combination; Hand Dermatoses - diagnosis; Hand Dermatoses - pathology; Hand Dermatoses - surgery; Humans; Interdisciplinary Communication; Male; Medical sciences; neutrophilic dermatosis of the dorsal hand; Orthopedics; Prednisone - administration & dosage; Pyoderma gangrenosum; Pyoderma Gangrenosum - diagnosis; Pyoderma Gangrenosum - pathology; Pyoderma Gangrenosum - surgery; Referral and Consultation; Skin - pathology; Skin involvement in other diseases. Miscellaneous. General aspects; Skin Neoplasms - diagnosis; Skin Neoplasms - pathology; Skin Neoplasms - surgery; squamous cell carcinoma; Sweet syndrome; Tumors of the skin and soft tissue. Premalignant lesions; amputation; Sweet syndrome; atypical pyoderma gangrenosum; Pyoderma gangrenosum; squamous cell carcinoma; neutrophilic dermatosis of the dorsal hand; Skin disease; Squamous cell carcinoma; Basal cell carcinoma; Malignant tumor; Hand; Treatment; Neutrophilic dermatosis; Surgical amputation; Surgery; Orthopedics; Atypical; Acute febrile neutrophilic dermatosis; Cancer
• ISSN: 0363-5023; 1531-6564
• DOI: 10.1016/j.jhsa.2012.06.019

We describe a rare case of atypical pyoderma gangrenosum of the dorsal hand in a patient who presented with the histopathologic diagnosis of squamous cell carcinoma (SCC). Atypical pyoderma gangrenosum is a rare variant of pyoderma gangrenosum that occurs on the upper extremities, presenting as a cutaneous ulcer. The correct treatment is nonsurgical, and surgical intervention often results in trauma-induced expansion of lesions. Pyoderma gangrenosum, most commonly mistaken for infection, has resulted in amputation. Histologic and clinical presentation 1 month after onset of symptoms in the patient reported here mimicked SCC. Awareness by hand surgeons of the possible histologic misdiagnosis of SCC at an early stage in the disease evolution and a high index of suspicion in the face of biopsy-proven SCC may prevent unnecessary digit amputation.