Wrist or Hand Tumor

Common Types of Wrist Tumors and Hand Tumors

• Ganglion Cysts (Figure 1): This is the most common tumor in the hand and wrist. Ganglion cysts are seen frequently in the wrist but can occur at the base of the fingers or around the finger joints. The cyst is typically filled with fluid from the joint, and it will feel very firm. There are several treatment options for a ganglion cyst, including observation (doing nothing), aspiration (puncturing with a needle) or surgically removing it.
• Giant cell tumor of the tendon sheath (Figure 2): This is the second most common hand tumor. Unlike the fluid-filled ganglion cyst, these tumors are solid. They are benign (not cancer) and slow growing. In most cases, these should be surgically removed as they can cause irritation and affect nearby parts of the hand such as bone, tendons, and joints. Recently, new medications have been approved to shrink these tumors, however it is important to be evaluated by a doctor or surgeon who has experience with these medications.
• Epidermal inclusion cyst (Figure 3): This tumor is benign and forms just underneath the skin where there may have been a cut or puncture. The cyst is filled with keratin, a soft, waxy material. The treatment for this is also removal.

There are other less common types of tumors seen in the hand, including lipomas (fatty tumors), schwannomas (nerve tumors), fibromas and glomus tumors, among others. Almost all are benign. Most can be safely observed or treated with surgery if they are causing symptoms.

Skin and Nail Tumors
Cancerous tumors can develop underneath the nail or on the skin of the hand. The most common types of these tumors are called melanoma or squamous cell cancer. Melanoma can come from areas in the skin that look like moles. Melanoma can also start under the nail and can look like a dark stripe under the nail (Figure 5). Squamous cell cancers can also start on the hand or by the nail. These may look like scaly areas that do not go away, and the growths can even break through the skin (Figure 6). These types of tumors usually require surgery with either a hand surgeon or dermatologist.

Bone Tumors
The majority of growths within the bones of the hand and wrist are not cancerous. The most common growth is called an enchondroma (a growth of cartilage within the bone). These are very common in the small bones of the hand. Bone tumors should be evaluated with an x-ray and occasionally an MRI. Most enchondromas do not need surgery and can be observed, however if the bone fractures because it is weak or the enchondroma is large, surgery may be needed to scrape out the tumor and strengthen the bone.

Cancerous Soft Tissue Tumors
There are very rare cancerous tumors that start from the soft tissue in the hand and wrist. These are called sarcomas. Sarcomas are usually slow growing, painless, and deep within the hand. They most often are evaluated with an MRI and a biopsy. Most sarcoma can be cured with surgery; however, it is important for your surgeon to be familiar with these types of rare tumors as they often require very specialized treatment. Your surgeon may refer you to a sarcoma specialist in these cases.

Other Causes of Bumps

Foreign bodies, such as a splinter, can cause reactions that form bumps in the hand. Dupuytren’s disease may cause firm bumps in the hand, which are often confused with tumors (Figure 4). Finally, blood vessel growths can also be confused with other tumors.

Diagnosis of Hand Tumors and Wrist Tumors

A physical exam and review of your medical history by a hand surgeon can help to determine the type of hand or wrist tumor you may have. X-rays might be taken to evaluate the bones, joints, and possibly the soft tissue. Other studies such as ultrasounds, CTs, MRIs or bone scans may be done to help narrow down the diagnosis. Needle biopsy or incisional biopsy (cutting out a small sample of the tumor) may be considered if the surgeon wants to confirm the diagnosis before recommending treatment.