In an extensive review of the literature, the median survival of patients with metastasis to the hand was 6 months [2]. Acrometastasis is generally a finding of late-stage, disseminated metastatic carcinoma [4]. This should be borne in mind when undergoing surgical decision-making to avoid extensive periods of recovery, or disability associated with postoperative protocol. When metastasis presents in the hand, and is symptomatic enough to justify surgical treatment, ablative surgery is usually preferred (Fig. 28.2). Particularly with involvement of the phalanges, interphalangeal amputation can effectively relieve pain, heal predictably, and preserve function. With proximal phalangeal or metacarpal involvement, a ray amputation can usually be accomplished with good preservation of function as well. Ray amputation is preferred to metacarpophalangeal amputation for both functional and cosmetic reasons. For metastasis involving the thumb, interphalangeal amputation has been shown to have a better functional outcome than metacarpophalangeal amputation [5].

Metastasis to the carpus is rare, but is reported, and it has been reported to be the initial presentation of malignancy [6]. In most cases surgical treatment will be limited to excision alone, or amputation . Arthrodesis should only be considered if a radical excision is to be performed and there is no plan for adjuvant radiation therapy, as radiation can have an inhibitory effect on fusion.