# Myoepithelioma of the Hand: A Systematic Review
## 4 Discussion
### Management  
Surgical excision is the cornerstone in treating myoepithelioma of the hand, aiming for complete removal to prevent recurrence, which accounts for almost 30% if the mass is not excised completely [28; 36]. This typically involves a wide local excision procedure, meticulously ensuring clear margins around the tumor. Given the hand's intricate anatomy and functional importance, achieving these negative margins can be particularly challenging but is crucial for long-term outcomes. Reconstructive surgery may follow depending on the tumor's size and location. This step not only focuses on removing the tumor but also aims to restore optimal function and the appearance of the affected hand. Techniques such as skin grafts or flap reconstruction may be employed to achieve these goals effectively. When spindle cell myoepithelioma involves bone, complete excision of the affected bone segment may be necessary, followed by reconstructive procedures, such as bone \begin{table}
\begin{tabular}{c c c c} \hline \hline  & **Myoepithelioma Differential Diagnosis** & & \\ \hline \multicolumn{2}{c}{**Clinical Features**} & **Histologic Features** & **Imaging** \\ \hline \multirow{3}{*}{Myoepithelioma} & \multirow{2}{*}{Slow growing} & S100 protein, EMA, CK7, & X-ray: may show bone erosion \\  & & AE1/AE3, calponin & MRI: low contrast T1, high contrast \\  & & & T2. May show tendon involvement \\ \hline \multirow{3}{*}{Schwannoma} & \multirow{3}{*}{Alongside nerve, +/-} & \multirow{3}{*}{SOX10, S100, NF, GFAP} & MRI: isointense to intermediate \\  & & sensitive or & & signals on T1 WI, heterogeneousously \\  & & motor impairments & & hyperintense signals on T2 WI, and \\  & & & & STIR with no suppression on fat \\  & & & & saturated sequences \\ \hline \multirow{3}{*}{Lipoma} & \multirow{3}{*}{Slippage sign} & S-100, CD34, Leptin & MRI: well-defined margins, \\  & & & & hyperintense in T1 WI and T2 WI \\ \hline \multirow{3}{*}{Smyorial Sarcoma} & \multirow{3}{*}{Slow growing single or lobulated} & \multirow{3}{*}{CK-pan, EMA, vimentin, BCL-2} & MRI: infiltrative margins, isointense \\  & & & & to muscle belly in T1 WI and \\  & & & BCL-2 & hyperintense in T2 WI. Typical \\  & & & & “triple signal” \\ \hline \multirow{3}{*}{Myoepithelial carcinoma} & \multirow{3}{*}{Slow growing firm mass} & CK-14, CK-7, CK-pan, EMA, & MRI: ill-defined margins, isointense \\  & & S100, calponin, HMW-CK, p63 & in T1, hyperintense in T2 \\ \hline \multirow{3}{*}{Myoepithelioma} & EMA = epithelial membrane antigen; CK7 = cytokeratin 7; AE = cytokeratin antibody; NF = neurofilament; & GFAP = glial fibrillary acidic protein; SOX-10 = SRY-box transcription factor 10; HMW-CK = high-molecular-weight cytokeratin; MRI = magnetic resonance imaging; WI = weighed images. \\  & & & \\ \hline \hline \end{tabular}
\end{table} 
Table 3: Differential diagnosis. grafting or flap reconstruction (e.g., toe-to-hand transfer) to restore function and aesthetics. This approach is crucial in maintaining the structural integrity of the hand while ensuring effective treatment [13]  
In cases where surgical margins are positive or in recurrent disease, adjuvant therapies are considered to manage residual disease or reduce the risk of recurrence. Radiotherapy is often utilized for its ability to target remaining cancerous cells [37], while chemotherapy remains reserved for cases demonstrating malignant behavior or metastatic potential [36]. A novel approach gaining attention involves a multidisciplinary strategy combining surgical excision with custom brachytherapy. This approach integrates precise radiation therapy directly into the surgical site, offering localized treatment while sparing healthy tissues. Such innovations are pivotal in enhancing treatment efficacy and minimizing potential side effects, thereby optimizing patient outcomes [11]. Adjuvant therapies, such as radiotherapy or chemotherapy, may be indicated in cases with positive margins or higher-risk features.