Cancer Invades Finger and Toe Bones
Swollen Digits Reveal Rare Metastatic Spread
A man’s severe toe and finger swelling presented a startling medical mystery, ultimately revealing that his bones had been almost entirely consumed by tumors.
A Rare and Aggressive Complication
Doctors in Australia recently documented the unusual case of a 55-year-old man whose seemingly minor symptoms were linked to an aggressive complication of his diagnosed metastatic squamous-cell lung cancer. The patient sought medical attention after experiencing several weeks of pain and significant swelling in one finger and one toe. Sadly, his condition proved fatal shortly after diagnosis.
The condition, known as acrometastases, involves cancer spreading beyond its primary site to the bones in the extremities, such as those beyond the elbows and knees. This phenomenon is exceptionally rare, affecting an estimated 0.1% of individuals with bone metastasis. While acrometastases can occasionally be the initial indicator of undetected, late-stage cancer, they typically follow other noticeable symptoms, as was the case here.
55-year-old man with metastatic squamous-cell lung cancer presented with a 6-week history of pain and swelling of the right great toe and the tip of the right middle finger.
Read the full case details in the Images in Clinical Medicine article “Acrometastases,” from @petermaccc… pic.twitter.com/SPwSuKVZHV
— Nejm (@NEJM) July 17, 2025
Diagnosis and Prognosis
The patient’s initial presentation included six weeks of intense pain and swelling in his right middle finger and right big toe, with an open sore noted under the toe’s nail. The affected areas were described as firm and tender to the touch. Medical professionals noted that acrometastases can often be mistaken for conditions like gout or osteomyelitis.
However, X-ray imaging clearly identified the cause: cancerous lesions that had completely overtaken the distal bones of his finger and toe. Acrometastases typically stem from cancers originating in the lungs, gastrointestinal tract, or urinary system and are more prevalent in men.
Survival rates for individuals diagnosed with acrometastases are generally low, as it signifies highly advanced cancer. Patients often have a life expectancy of less than six months post-diagnosis. In this particular instance, physicians administered palliative radiotherapy to manage the patient’s symptoms. Tragically, he passed away approximately three weeks later due to refractory hypercalcemia, a severe and unresponsive elevation of calcium levels in the blood, which is itself a frequent complication of advanced cancer.
The rarity of acrometastases underscores the importance of thorough investigation for persistent, unexplained swelling or pain in the extremities, especially in individuals with a history of cancer. Recent studies highlight that aggressive cancer treatments are continuously evolving, with research into novel therapies like oncolytic viruses showing promise in fighting advanced disease (Salk Institute, 2024).
