case_images: PMC6711107_01
case_images: Lesion on the right thumb shown in December of 2016 prior to surgical treatment.
case_images: ICRP_A_1647108_F0001_C.jpg
case_images: PMC6711107_01_ICRP_A_1647108_F0001_C.jpg
case_images: F0001
case_images: A 56-year-old male was referred to the plastic surgery clinic with a four-year history of a skin lesion on the dorsum of his right thumb (Figure 1).
case_images: Initial patient presentation to the plastic surgery clinic in August of 2017 post initial surgery demonstrating the recurrence of the lesion on the dorsum of the right thumb interphalageal joint.
case_images: ICRP_A_1647108_F0002_C.jpg
case_images: PMC6711107_01_ICRP_A_1647108_F0002_C.jpg
case_images: F0002
case_images: On physical examination the patient had a 1.8cm by 1.3cm well circumcised indurated lesion over the dorsum of his right thumb stump (Figure 2).
case_images: (a,b) Images taken two weeks apart showing aggressive re-occurrence of the lesion after the second surgery in April of 2018.
case_images: ICRP_A_1647108_F0003_C.jpg
case_images: PMC6711107_01_ICRP_A_1647108_F0003_C.jpg
case_images: F0003
case_images: Seven months after surgery, a suspicious lesion was identified in the scar of the right amputated thumb (Figures 3a,b).
case_images: (a,b) Images taken after the third surgery in 2018 showing final functional ability.
case_images: ICRP_A_1647108_F0004_C.jpg
case_images: PMC6711107_01_ICRP_A_1647108_F0004_C.jpg
case_images: F0004
case_images: During the second excision the plastic surgery team completed a transfer of the flexor pollicis longus tendon to the distal bone stump to help maintain some of the adduction strength of the thumb (Figures 4 a,b).