Lumps and Bumps: Common Tumours of The Hand

It is not uncommon for growths to form on your finger or wrist, so it is best to learn about the different types and how they are treated.

Any number and variety of swellings may arise from the tissues in the hand. These include growths arising from the skin, tendons, muscle, nerve, blood vessels or bone. Most of these swellings and growths are benign. They may cause symptoms such as:

• A swelling or lump that may appear gradually or suddenly
• Pain in the affected area
• Pain that worsens with movement Loss of joint flexibility
• Weakness in the affected finger or wrist
• Numbness or tingling in the affected hand

There is no known cause for many hand tumours and cysts but some risk factors include arthritis, smoking, exposure to radiation, or activities that put pressure and strain on the joints, such as gymnastics or tennis.

Common cysts

One of the most common hand swellings is called a ganglion cyst. These are benign sacs of viscous gelatinous fluid that form in the joint or tendon sheath of the wrist and finger joints. These are caused when the connective tissue in the joint capsule or tendon sheath balloons out and becomes filled with the fluid that lubricates the joint or tendon. They commonly occur at the back or front of the wrist, the base of the finger or over the last joint (distal) of the finger. While it is often harmless, a ganglion cyst can cause pain if it grows large enough to impinge on nerves or muscles. It can also interfere with hand function. A conservative approach would be to restrict activities in the affected area with a brace. Aspiration to suck out the fluid with a needle may provide temporary relief from symptoms. Surgery may be helpful in removing the cyst. After surgery, some cysts may recur (20%).

The second most common hand growth is called a giant cell tumour of tendon sheath. Unlike the fluid-filled ganglion cysts, these benign tumours are solid and nodular. Hence they are also known as villonodular synovitis. It is not known what causes them, but it may be related to prior trauma to the area. Some patients may present when the tumour is already very big as it is usually painless and slow growing. Surgery is recommended, as it will continue to grow in size.

Lipoma, a benign tumour of fatty tissues is the most common soft tissue tumour in the body. While these do not often cause any symptoms, they can compress nerves. When these fatty growths occur in the hand, they can press on a nerve in the carpal tunnel, causing carpal tunnel syndrome. Surgery can be helpful in removing the pressure on the nerve and relieving symptoms.

Another common hand growth is the epidermalinclusion cyst. This painless benign mass usually forms just beneath the skin. It is formed when skin cells get trapped under the surface -often after a cut or puncture to the skin – and continue to reproduce and slough. The cells get trapped underneath the skin and the result is a fibrous sac filled with a waxy substance. A surgical procedure can be done to remove the growth.

Other less common and benign types of hand and wrist growths include nerve sheath tumours, neuromas, fibromas, and glomus tumours.

Treatment initially will be conservative, involving postural changes, activity modxry.

Is it cancer?

One of the common concerns a patient has when discovering a lump or bump in their hand is whether or not they have cancer (malignancy). Fortunately, malignant lesion in the hand is not common, but it is still important to be aware of the signs and symptoms and seek timely medical advice. Your doctor, after an examination, may order some tests including X rays, ultrasound or MRI. If it is malignant, surgery to remove the affected area is required and long-term surveillance is important to detect any recurrence. Some examples of growths in the hand that are of concern include:

• Squamous cell carcinoma is the most common malignant tumour in the hand and is linked to pre­ existing lesions such as chronic wounds, previous burn injuries or lesions associated with genetic skin disorders. These growths may look dry with crusty scabs or non-healing ulcers.
• Malignant melanoma is the most common fatal skin cancer and may arise from a pre-existing pigmented lesion. The signs include moles or pigmented skin that suddenly grow in size, develop nodules, change colour, bleed or itch or develop into ulcers.
• Giant cell tumour is usually considered a benign bony lesion if it occurs in other parts of the body, but when it occurs in the hand, it can become aggressive and spread, leading to severe and even fatal outcomes. These growths often occur with pain and swelling and may be the result of having a fracture in the bones of the arm or hand. Surgery to remove the growth may be followed by bone grafting to replace the lost bone.
• Chondrosarcoma is a malignant bone tumour. It happens more commonly in the elderly aged 70 to 80. It is is slow growing, but can be painful. Apart from checking the rest of the fingers and hand for any sign of spreading tumour, the lungs also need to be screened as this type of tumour often spreads to the chest.
• Metastatic tumours are uncommon. They are due to secondary deposits of cancer cells that spread from other areas of the body to the fingers, hand and wrist.

With all this in mind, it is important to remember that we need our hands for so many important activities in life. So we should always take care of them and check them, especially if we notice any swellings or experience discomfort or pain.