Palmar squamous cell carcinoma with lymph node involvement: a case report highlighting diagnostic challenges

Introduction: Cutaneous squamous cell carcinoma (SCC) commonly affects sun-exposed areas, particularly the dorsum of the hand. However, palmar SCC is rare and can remain undiagnosed for a prolonged period. This case describes a unique instance of SCC originating from the palm with metastasis, initially misdiagnosed as primary breast cancer. Case Presentation: A 75-year-old woman, a retired agricultural laborer, presented with a chronic ulcerated mass on her right palm, with associated weight loss and regional nodal swellings. She had a traumatic palm injury treated with skin grafting 12 years prior. She previously underwent axillary and breast surgeries for lesions diagnosed as SCC, presumed to be of breast origin. Current examination revealed a 2.5 × 2 cm palmar mass and multiple nodal swellings. Biopsies confirmed well-differentiated SCC at all sites, and imaging showed no distant metastases but significant right-sided nodal involvement. The patient underwent wide local excision of the palm, modified radical mastectomy, and neck dissection, followed by split-thickness skin grafting. Recovery was uneventful. Clinical Discussion: Palmar SCC may arise from chronic inflammatory changes or trauma rather than UV exposure, as seen in this case. Misdiagnosis delayed appropriate treatment and allowed for significant nodal progression. SCC in atypical sites can be aggressive and necessitate early, multidisciplinary intervention. Conclusion: Palmar squamous cell carcinoma, although rare, must be considered in chronic non-healing hand ulcers, especially in patients with previous trauma or grafting. Thorough clinical correlation with histopathology, early biopsy, and prompt surgical management are essential to reduce morbidity from metastatic spread.