English: This 64 year old man had 5 years previously noticed a small lump on the dorsum of his left hand. This had gradually increased in size over 2 years; it had become painful and the skin started to ulcerate over it. He refused local resection at this stage. The lesion progressed to an enormous ulcer with severe pain, and infiltration and involvement of tendons and nerves of the medial three fingers. He underwent amputation of the forearm 2 inches below the elbow.