A tumor refers to any abnormal swelling or lump. It does not necessarily mean it is malignant or cancerous. In fact, majority of hand tumors are benign (non-cancerous).
Hand tumors can occur anywhere on the skin, like a mole or a wart, or can occur underneath the skin in the soft tissue or even the bone. There are many types of tumors that can occur but only a few of them are common.
Common Soft Tissue Tumour of the Hand
Ganglion cyst. This is the most common tumor in the hand and wrist. They are benign sacs of gelatinous clear fluid that form off of a joint or tendon sheath. They frequently appear in the wrist but can also occur around finger joints. Click here to learn more. (hyperlink to ganglion article)
Giant cell tumor of tendon sheath. This is the 2nd most common hand tumor. They are solid masses and can occur anywhere in the hand nearby any tendon sheath. They are benign (non-cancerous), slow-growing masses that spread through the soft tissue and sometimes into the joints.
Epidermal inclusion cyst. This is also a common benign tumor. It forms just underneath the skin, originating from the undersurface of the skin where there may have been a cut or puncture. Skin cells normally secrete a protective waxy substance called keratin. They also undergo a cycle in which surface skin cells die and slough off into the environment. When skin cells get trapped under the surface, they continue to make keratin and continue to reproduce and slough. The keratin and dead skin cells get trapped underneath the skin and start forming the cyst. The cyst grows as more keratin is produced and more skin cells die. Ultimately, you get a fibrous sac filled with a cheesy substance that is attached to the undersurface of the skin from where it arose.
There are other less common types of soft tissue tumors seen in the hand. They include lipomas (fatty tumors), nerve tumors, fibromas, and glomus tumors among others. They are practically all benign. Foreign bodies, like a splinter, can also cause reactions that form lumps or bumps in the hand (foreign body granulomas).
Common Bone Tumour of the Hand
Enchondroma and exostosis (osteochondromas) are common benign (noncancerous) tumour of the hand. They are cartilage tumor of the bone. Enchondroma appears on the inside of the bone while exostosis appears on the outside of the bone near the joints. These tumors usually begin and grow in childhood, then stop growing but remain present throughout adulthood. They are often found in patients between 10 and 20 years of age.
Enchondroma can be discovered accidentally in X-rays of the hand or the patient may present with a fracture because the tumor weakens the bony structure. In rare cases of enchondroma, multiple tumors can appear as part of a syndrome. These syndromes are Ollier’s disease and Maffucci’s syndrome. Single enchondromas can become cancerous, but very rare. The rate of cancerous change is higher in Ollier’s disease and Maffucci’s syndrome.
Osteochondromas may grow in size as the child grows and stop growing in size when the child reaches full height. In most cases, osteochondromas don’t create problems and treatment isn’t needed. Surgery is only necessary if the tumor is causing significant pain, putting pressure on blood vessels or nerves, or very large in size.
Malignant tumour of the Hand
Cancer in the hand is very rare. The most common primary hand malignancies are skin cancers like squamous cell carcinoma, basal cell carcinoma, or melanoma. Other cancers are very rare such as sarcomas of the soft tissue or bone. Sometimes, cancer can spread to the hand from other sites in the body, such as the lung cancer. This is called metastatic cancer.
Evaluation of tumour
A thorough history and physical exam performed by a hand surgeon can help narrow down types of tumour. Informations such as pain, progression of swelling, limitation of joint motion and skin ulceration are important. X-rays may be performed to look for bony involvement or to evaluate the soft tissue for any calcifications. Sometimes, further imaging like ultrasound can be ordered to differentiate a cyctic or a solid mass. MRI scan may be helpful in differentiating an infection or certain types of tumors.
Generally, if the suspected tumor is benign such as a ganglion or lipoma, the definitive treatment is surgical excision of the tumor. Excising the tumor also allows a pathologist to stain and look at it under microscopic examination and determine the type of tumor with reasonable certainty. Most benign tumors can be cured with surgery such as ganglion cyst, lipoma, epidermal inclusion cyst. However, some may recur such as ganglion, and giant cell tumor of the tendon sheath.
If the tumor is a ganglion cyst, aspiration of the cyst may be an option if the patient does not want surgery, although recurrence is common.
Sometimes, needle biopsy or incisional biopsy may be considered for a dubious solid tumor where malignancy is suspected. The tissue from this small biopsy will allow the pathologist to make a tissue diagnosis before the surgeon recommends definitive treatment.
If the tumor is determined to be benign, some patients may choose to do nothing and simply live with the tumor. They will be monitor regularly as these tumors may get bigger with time and can become more of a nuisance then. Surgery to remove them can always be done later.