Initial investigation of this dorsal hand mass involved an ultrasound which revealed a heterogeneous vascular lesion. This lesion was further characterized with MRI of the affected hand which demonstrated a nonspecific soft tissue lesion, prompting further workup.

A biopsy of the lesion was performed using a dorsal approach. Formal histological analysis confirmed a diagnosis of Ewing sarcoma. 

Following diagnosis, staging imaging was performed. Fortunately, no sites of metastatic disease were identified. The patient went on to have neoadjuvant chemoradiotherapy prior to undergoing a fourth and fifth ray amputation of the left hand as definitive surgical treatment for the tumor. A local fasciocutaneous advancement flap and reconstruction was required to attain closure and adequate cosmetic outcome following the aforementioned ray amputations.