ABSTRACT

A broad spectrum of benign and malignant tumours and tumour-like features can arise from the hand. Thankfully, the majority of these will be benign,1 of which ganglions, epidermoid cysts, giant cell tumours of tendon sheath and the nodules of Dupuytren will constitute the majority.2,3

As in other parts of the musculoskeletal system, the principles of diagnosis and treatment remain the same, that is timely assessment by a multidisciplinary team, with a musculoskeletal radiologist and a pathologist (Fig. 120.1). Before definitive treatment, the surgeon should be confident of the diagnosis. In certain cases, it may be appropriate to rely on the combination of clinical picture and radiological findings, if the imaging has been reviewed by an experienced musculoskeletal radiologist. If a tissue diagnosis is required, a Trucut needle biopsy or open biopsy may be performed (rather than fine needle aspiration for cytology). In some cases, such as in the distal finger, where amputation is the only option if a malignancy is diagnosed, an excision biopsy may be appropriate. The biopsy should be performed by the surgeon performing the

definitive surgery, along sound oncological principles, which are covered in chapter 79.