The mass was excised. The lesion appeared well encapsulated and was removed en toto. The skin overlying the lesion appeared to be normal.
Histologic examination revealed a spindle cell melanoma. Because the overlying skin was spared during excision, the lesion could not be staged, although the mass had a thickness of over 1 cm.
The patient was referred to a surgical oncologist and underwent wide local excision along with sentinel node biopsy. The wound was covered with a split-thickness skin graft. The margins were clear in the second procedure, as were his sentinel node biopsy specimens. Results of a metastatic workup including computed tomography and magnetic resonance imaging were negative. He has regular oncology follow-up and remains free of disease, with no limitations in his activities.
Nearly 2 percent of chronic burn scars can transform into malignant lesions years after the burn, most commonly squamous cell and basal cell carcinomas and rarely malignant melanoma.1–3 Carcinomas arising in burns are rare and are also known as Marjolin ulcers,3 in reference to the Parisian surgeon Jean-Nicolas Marjolin who, in 1828, described trauma- and burn-induced skin lesions. Interestingly enough, Marjolin himself had never correlated the progression of a burn ulcer to carcinoma.
The cause of carcinomas arising from burn scars is unknown; however, thermal injury is thought to be the primary cause.4 Others have theorized that the local environment at the periphery of the burn scar is not accessible to the body's natural immunosurveillance.5 Supporters of this theory cite that the dense fibrous tissue in addition to the altered lymphatics at the burn site do not allow the tumor's antigens to reach the regional lymph nodes and thus the body's immunologic system does not recognize the carcinoma, allowing it to grow.
Early intervention in burns can assist in preventing burn scar carcinoma. A combination of wound débridement and coverage with biomaterial and antimicrobials when needed can prevent malignant transformation of the wound. Treatment of carcinomas arising within a burn scar consists of wide local excision with graft coverage along with node dissection.
Jordan S. Sheff, D.P.M.
Thomas A. Pane, M.D.
1.Akiyama M, Inamoto N, Nakamura K. Malignant melanoma and squamous cell carcinoma forming one tumor on a burn scar. Dermatology
2.Kikuchia H, Nishida T, Kurokawa M, Setoyama M, Kisanuki A. Three cases of malignant melanoma arising on burn scars. J Dermatol
3.Steffen C. The man behind the eponym: Jean-Nicholas Marjolin. Am J Dermatopathol
4.Treves N, Pack GT. The development of cancer in burn scars: An analysis and report of thirty four cases. Surg Gynecol Obstet
5.Futrell JW, Myers GH Jr. The burn scar as an immunologically deprived site. Surg Forum
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