Trauma Center, Gamma Knife Center, Department of Neurosurgery, Cannizzaro Hospital, 95126 Catania, Italy
Gianluca Scalia
Department of Neurosurgery, Highly Specialized Hospital and of National Importance “Garibaldi”, 95122 Catania, Italy
Paolo Palmisciano
Trauma Center, Gamma Knife Center, Department of Neurosurgery, Cannizzaro Hospital, 95126 Catania, Italy
Maurizio Passanisi
Trauma Center, Gamma Knife Center, Department of Neurosurgery, Cannizzaro Hospital, 95126 Catania, Italy
Valerio Da Ros
Department of Biomedicine and Prevention, University Hospital of Rome “Tor Vergata”, 00133 Rome, Italy
Gianluca Pompili
Plastic Surgery Unit, Cannizzaro Hospital, 95126 Catania, Italy
Fabio Barone
Trauma Center, Gamma Knife Center, Department of Neurosurgery, Cannizzaro Hospital, 95126 Catania, Italy
Paolo Amico
Department of Pathological Anatomy, Cannizzaro Hospital, 95126 Catania, Italy
Santino Ottavio Tomasi
Department of Neurological Surgery, Christian Doppler Klinik Paracelsus Medical University, 5020 Salzburg, Austria
Francesca Graziano
Department of Neurosurgery, Highly Specialized Hospital and of National Importance “Garibaldi”, 95122 Catania, Italy
Iolanda Valeria Patti
Medical Physics Unit, Cannizzaro Hospital, 95126 Catania, Italy
Stefania Mele
Medical Physics Unit, Cannizzaro Hospital, 95126 Catania, Italy
Rosario Maugeri
Post-Graduate Residency Programme in Neurological Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Neurosurgical Clinic, AOUP “Paolo Giaccone”, 90127 Palermo, Italy
Giovanni Raffa
BIOMORF Department, Division of Neurosurgery, University of Messina, 98124 Messina, Italy
Giuseppe Roberto Giammalva
Post-Graduate Residency Programme in Neurological Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Neurosurgical Clinic, AOUP “Paolo Giaccone”, 90127 Palermo, Italy
Gerardo Domenico Iacopino
Post-Graduate Residency Programme in Neurological Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Neurosurgical Clinic, AOUP “Paolo Giaccone”, 90127 Palermo, Italy
Antonino Germanò
BIOMORF Department, Division of Neurosurgery, University of Messina, 98124 Messina, Italy
Giovanni Federico Nicoletti
Department of Neurosurgery, Highly Specialized Hospital and of National Importance “Garibaldi”, 95122 Catania, Italy
Massimo Ippolito
Department of Advanced Technologies, Nuclear Medicine and PET Cannizzaro Hospital, 95126 Catania, Italy
Maria Gabriella Sabini
Medical Physics Unit, Cannizzaro Hospital, 95126 Catania, Italy
Salvatore Cicero
Trauma Center, Gamma Knife Center, Department of Neurosurgery, Cannizzaro Hospital, 95126 Catania, Italy
Lidia Strigari
Department of Medical Physics, IRCCS University Hospital of Bologna, 40138 Bologna, Italy
Giacomo Cuttone
INFN-Laboratori Nazionali del Sud, Via S. Sofia 62, 95123 Catania, Italy
Background and Objectives: The term acrometastases (AM) refers to secondary lesions sited distally to the elbow and knee, representing 0.1% of all bony metastases. By frequency, pulmonary cancer and gastrointestinal and genitourinary tract neoplasms are the most responsible for the reported AM. Improvements in oncologic patient care favor an increase in the incidence of such rare cases. We performed a systematic review of acrometastases to the hand to provide further insight into the management of these fragile patients. We also present a peculiar case of simultaneous acrometastasis to the ring finger and pathological vertebral fracture. Material and Methods: A literature search according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement was conducted using the PubMed, Google Scholar, and Scopus databases in December 2020 on metastasis to the hand and wrist, from 1986 to 2020. MeSH terms included acrometastasis, carpal metastasis, hand metastasis, finger metastasis, phalangeal metastasis, and wrist metastasis. Results: In total, 215 studies reporting the follow-up of 247 patients were analyzed, with a median age of 62 years (range 10–91 years). Overall, 162 out of 247 patients were males (65.6%) and 85 were females (34.4%). The median reported follow-up was 5 months (range 0.5–39). The median time from primary tumor diagnosis to acrometastasis was 24 months (range 0.7–156). Acrometastases were located at the finger/phalanx (68.4%), carpal (14.2%), metacarpal (14.2%), or other sites (3.2%). The primary tumors were pulmonary in 91 patients (36.8%). The average interval from primary tumor diagnosis to acrometastasis varied according to the primary tumor type from 2 months (in patients with mesenchymal tumors) to 64.0 months (in patients with breast cancer). Conclusions: Acrometastases usually develop in the late stage of oncologic disease and are associated with short life expectancy. Their occurrence can no longer be considered rare; physicians should thus be updated on their surgical management and their impact on prognosis and survival.
