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Ma E, Ge S, Rush WL, Allbritton J. Malignant melanoma arising in a burn scar. Arch Dermatol Res 2024; 316:146. [PMID: 38696005 DOI: 10.1007/s00403-024-02861-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 02/01/2024] [Accepted: 04/07/2024] [Indexed: 06/05/2024]
Abstract
Secondary malignancies are rare but devastating complications of longstanding burn scars. Squamous cell carcinoma is the most common, followed by basal cell carcinoma and melanomas. There are fewer than 50 total reported cases of malignant melanomas arising in burn scars. We report a case of malignant melanoma arising within a longstanding burn scar confirmed by histology, FISH, and PRAME staining to further characterize melanomas arising in burn scars and to illustrate the diagnostic challenges they present.
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Affiliation(s)
- Emily Ma
- University of Maryland School of Medicine, Baltimore Maryland, USA
| | - Shealinna Ge
- Department of Dermatology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Walter L Rush
- Joint Pathology Center, 606 Stephen Sitter Avenue, Silver Spring, MD, 20910, USA
| | - Jill Allbritton
- Joint Pathology Center, 606 Stephen Sitter Avenue, Silver Spring, MD, 20910, USA.
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Burusapat C, Wanichjaroen N, Wongprakob N, Satayasoontorn K. Characteristics of Marjolin's Ulcers in 21st Century: A Retrospective Study, Systematic Review, and Surgical Guideline Recommendation. J Burn Care Res 2020; 42:152-166. [PMID: 33128365 DOI: 10.1093/jbcr/iraa196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Marjolin's ulcer is rare and aggressive malignancy. The objective was to conduct a review of Marjolin's ulcer cases to gain a better understanding and its management. A retrospective study of patients with Marjolin's ulcers at our hospital between 2010 and 2019 was conducted. For the systematic review, the electronic database of the National Library of Medicine was searched and articles published between 2000 and 2019 were included. A total of 14 patients were included in the retrospective study. Twelve patients were male. The mean age was 59.71 years. The latency period was 27.78 years. The most common malignancy was squamous cell carcinoma, and 71.43% had developed on the lower extremities. Well-differentiated squamous cell carcinomas occurred in 38.46% of the cases Rates of lymphovascular and perineural invasion were 30.77 and 23.08%, respectively. Results from the literature search yielded 80 case reports (91 cases) and 42 retrospective reviews (1216 cases). Most cases were male and the most common location was lower extremities. The latency period for the acute and chronic periods was 2.75 months and 20.75 years, respectively. The most common malignancy was squamous cell carcinoma (92.27% in the retrospective reviews) and 59.98% of the cases exhibited well-differentiation. Rates of regional lymph node involvement and distant metastases were 10.20 and 12.09%, respectively. Marjolin's ulcer in 21st century is not so rare. The most common is well differentiated squamous cell carcinoma. Early flap surgery or skin grafts for chronic ulcers or burn scars are recommended to reduce risk. Guideline for surgical management is established.
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Affiliation(s)
- Chairat Burusapat
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Nutthapong Wanichjaroen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Nuttadon Wongprakob
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Kantang Satayasoontorn
- Department of Pathology and Laboratory Medicine, Phramongkutklao Hospital, Bangkok, Thailand
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Serras RP, Rasteiro DC, Mendes MM, Mouzinho MM. Melanoma Marjolin's ulcer in the hand: A case report. Int J Surg Case Rep 2019; 60:345-347. [PMID: 31280068 PMCID: PMC6614109 DOI: 10.1016/j.ijscr.2019.06.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 06/16/2019] [Indexed: 12/05/2022] Open
Abstract
Marjolin’s ulcer is usually misdiagnosed. Some theories try to explain the mechanisms of malignant degeneration. Melanoma is rare and aggressive and, once suspected, a biopsy must be done. Deep second and third degree burns must be debrided and covered by a skin graft. Early diagnosis, treatment and vigilance are the keys to success and survival.
Introduction Burn scars have the potential to malignant transformation, creating an identity named Marjolin’s ulcer. This term refers to any scar in a traumatized skin that degenerates into a skin cancer. The majority of them are derived from burns that were not grafted, appearing several years later. The most frequent type is squamous cell carcinoma with few cases of melanoma described in the literature. This last one accounts for a poor prognosis. Case presentation Female, 74 years old, presents to our department with a malignant melanoma arising from a thermal burn scar in the right thenar eminence 14 years after the initial injury. The lesion was excised and the defect covered by a full thickness skin graft. At 6 months post-operatively there are no signs of locoregional recurrence or systemic dissemination. Discussion Malignant melanoma arising from a burn scar is extremely rare and the pathogenesis is unknown. Many theories try to explain this low incidence and the factors that contribute to degenerative changes of melanocytes in the affected skin. Conclusion Health professionals must consider this pathology when evaluating a burn scar or a chronic wound, performing a biopsy when suspicion is high. An early diagnosis, a prompt surgical intervention and a greater vigilance are the keys to success and survival.
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Affiliation(s)
- Rafaela Pais Serras
- Department of Plastic and Reconstructive Surgery, Hospital de São José, 1150-199, Lisbon, Portugal.
| | - David Carvalho Rasteiro
- Department of Plastic and Reconstructive Surgery, Hospital de São José, 1150-199, Lisbon, Portugal
| | - Maria Manuel Mendes
- Department of Plastic and Reconstructive Surgery, Hospital de São José, 1150-199, Lisbon, Portugal
| | - Maria Manuel Mouzinho
- Department of Plastic and Reconstructive Surgery, Hospital de São José, 1150-199, Lisbon, Portugal
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Lee HB, Han SE, Chang LS, Lee SH. Malignant melanoma on a thermal burn scar. Arch Craniofac Surg 2019; 20:58-61. [PMID: 30703864 PMCID: PMC6411517 DOI: 10.7181/acfs.2018.02103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 10/02/2018] [Indexed: 11/11/2022] Open
Abstract
Chronic burn scars often cause various skin malignancies at rates of up to 2%. These lesions are usually squamous cell carcinomas, but rarely, malignant melanoma is reported. We report a 67-year-old male with a malignant melanoma on a burn scar with regional metastasis. This patient presented an ulcerative lesion only in 2 weeks. After histopathological diagnosis, we performed only palliative surgery on patient’s demand, and followed up the subsequent deterioration course. Our case reemphasizes the need for rapid diagnosis and treatment when suspect lesions are present on chronic burn scar. Also, physician should be in mind and inform the patient about malignant melanoma and its aggressive course.
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Affiliation(s)
- Han Byul Lee
- Department of Plastic and Reconstructive Surgery, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - So Eun Han
- Department of Plastic and Reconstructive Surgery, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Lan Sook Chang
- Department of Plastic and Reconstructive Surgery, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Soo Hyang Lee
- Department of Plastic and Reconstructive Surgery, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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Multiple melanoma arising on a burn scar and extensive sunburn: a case report and a review of the literature. Melanoma Res 2009; 19:195-8. [DOI: 10.1097/cmr.0b013e32832ccd3f] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Mseddi M, Frigui F, Abdelmaksoud W, Marrekchi S, Bouassida S, Turki H. Mélanome multiple polymétastatique sur cicatrice de brûlure. ONCOLOGIE 2007. [DOI: 10.1007/s10269-007-0740-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Cobey FC, Engrav LH, Klein MB, Isom CN, Byrd DR. Brief report: sentinel lymph node dissection and burn scar carcinoma sentinel node and burn scar carcinoma. Burns 2007; 34:271-4. [PMID: 17374455 DOI: 10.1016/j.burns.2006.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2005] [Accepted: 09/29/2006] [Indexed: 11/24/2022]
Affiliation(s)
- Frederick C Cobey
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard University, 75 Francis Street, Boston, MA 02115, United States.
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Bero SM, Busam KJ, Brady MS. Cutaneous melanoma arising in a burn scar: two recent cases and a review of the literature. Melanoma Res 2006; 16:71-6. [PMID: 16432459 DOI: 10.1097/01.cmr.0000194428.39525.87] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Melanoma arising in a burn scar is extremely uncommon. We report two recent cases, including one patient in whom six distinct primary melanomas arose in the setting of an extensive truncal burn scar. Only 27 patients have been reported previously, and only three previous cases of multiple primary melanomas arising in a burn scar have been described.
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Chun JK, Singer E, Kong A, Phelps R, Weltz C. Desmoplastic amelanotic melanoma in an irradiated burn scar. Dermatol Surg 2006; 32:161-4. [PMID: 16393619 DOI: 10.1111/1524-4725.2006.32026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jin K Chun
- Dept. of Surgery, Division of Plastic and Reconstructive Surgery, The Mount Sinai Hospital, One Gustave Levy Place, New York, NY 10029, USA.
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Kowal-Vern A, Criswell BK. Burn scar neoplasms: a literature review and statistical analysis. Burns 2005; 31:403-13. [PMID: 15896501 DOI: 10.1016/j.burns.2005.02.015] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2004] [Accepted: 02/21/2005] [Indexed: 01/06/2023]
Abstract
BACKGROUND Although squamous cell carcinoma (SCC) is the most common burn scar neoplasm, other neoplasms have also been reported. OBJECTIVE To compile the burn scar neoplasm cases in the literature and to analyze their frequency and demographic characteristics. MATERIALS AND METHODS Cases were obtained through literature searches. RESULTS There were 412 cases gleaned from 146 articles between 1923 and 2004. Seventy-one percent (293) of the tumors were squamous cell carcinoma, 12% (48) were basal cell carcinoma (BCC), 6% (23) were melanoma, 5% (21) were sarcoma, 4% (16) were other neoplasms, 1% (6) were squamo-basal cell carcinoma, and 1% (5) squamous cell-melanoma. The mean age at tumor diagnosis was 50 years, the mean age at the time of burn injury was 20 years, the mean latency interval was 31 years. Only 5% of the reported cases were excised and grafted at the time of injury (p<0.001). BCC occurred at a significantly later age compared to SCC and sarcoma groups (p<0.02) and had a shorter latency period compared to SCC and sarcoma groups (p<0.004) and melanoma (p<0.008). Local recurrence was present in 16% of the cases, while regional lymph node involvement was seen in 22% of the cases and distant metastases was present in 14% of the patients. The mortality rate was 21%. CONCLUSIONS Although the main burn scar neoplasm was SCC, other neoplasms contributed to the morbidity and mortality of burn patients. Excision and grafting of deep burns, and close follow-up of non-healing ulcerated burn scars is essential for the prevention and early detection of burn scar neoplasms.
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Affiliation(s)
- Areta Kowal-Vern
- Sumner L. Koch Burn Center, Department of Trauma, John H. Stroger, Jr. Hospital of Cook County, 1901 West Harrison Street, Room 3229, Chicago, IL 60612, USA.
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Nemoto I, Akiyama N, Aoyagi S, Nomura T, Shimizu H. Eccrine porocarcinoma and eccrine poroma arising in a scar. Br J Dermatol 2004; 150:1232-3. [PMID: 15214932 DOI: 10.1111/j.1365-2133.2004.05997.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kikuchi H, Nishida T, Kurokawa M, Setoyama M, Kisanuki A. Three cases of malignant melanoma arising on burn scars. J Dermatol 2003; 30:617-24. [PMID: 12928532 DOI: 10.1111/j.1346-8138.2003.tb00445.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2002] [Accepted: 05/06/2003] [Indexed: 11/28/2022]
Abstract
It is well known that up to 2% of chronic burn scar lesions can transform into malignant tumors. Most of them are squamous cell carcinoma (SCC) and, more occasionally, basal cell carcinoma (BCC). The incidence of malignant melanoma (MM) is extremely low. To the best of our knowledge, there are only 23 such cases reported in the literature. We report here three cases of MM arising on burn scars and analyze the 23 cases reported previously. Case 1: a 74-year-old Japanese man sustained a burn injury on about 54% of his whole body surface when he was accidentally bathed in boiling oil at the age of 37 years old. Some small tumors developed on the burn scar on his right lumbar region. A wide excision of the tumor was performed. Case 2: a 51-year-old Japanese woman was injured on her right forearm and face by deep burns from a flame when she was 7 months old. She presented with a rapidly growing, painless black nodule on the dark skin lesion on her right forearm. She was treated with a wide excision followed by a full-thickness skin graft. Intravenous administration of one unit of OK-432 every week has been continued. Case 3: a 73-year-old Japanese woman was burned on her left leg and hand from a flame when she was 6 years old. A nodular lesion appeared within the ulcer two months previously and it was growing rapidly. This lesion was ulcerated on the top of its central area and was slightly reddish without any pigmentation. The patient was treated with a wide excision and a split-thickness skin graft. The 5-year survival rate of MM in an old burn scar is 53.6%. It is suggested that the prognosis of burn scar carcinoma is not worse than that of non-burn scar carcinoma.
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Affiliation(s)
- Hidezumi Kikuchi
- Department of Dermatology, Miyazaki Medical University, Miyazaki, Japan
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Rohwedder A, Philips B, Malfetano J, Kredentser D, Carlson JA. Vulvar malignant melanoma associated with human papillomavirus DNA: report of two cases and review of literature. Am J Dermatopathol 2002; 24:230-40. [PMID: 12140440 DOI: 10.1097/00000372-200206000-00008] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Oncogenic human papillomavirus (HPV) types such as HPV 16 are known to play a crucial role in the development of anogenital carcinomas. The etiology of anogenital malignant melanoma is unknown. We report two case of vulvar malignant melanoma in which multiple HPV types including HPV 16 and putative novel HPV types (alb-1, alb-2, alb-7, and alb-10) were identified by degenerated nested polymerase chain techniques (polymerase chain reaction) in both the malignant melanoma and surrounding skin. One melanoma was associated with lichen sclerosus, and the other, with melanoma in situ and pigmented vulvar squamous papillomatosis. These melanomas harbored HPV types alb-7, and HPV 16 as well as alb-1, respectively. HPV types 16, 20, 21, 36, alb-2, and AJ001060 were detected in vulvar skin affected by lichen sclerosus. Vulvar squamous papillomatosis harbored HPV types 28 and alb-10. HPV 16 was physically integrated into the host genome in lichen sclerosus skin and possibly in the melanoma associated with pigmented vulvar squamous papillomatosis. Twenty-two percent (4 of 18) of normal control specimens from skin tumor excisions were found to harbor HPV DNA (HPV types 3, 54, and alb-7); none of these control samples harbored multiple HPV DNA. These findings of multiple HPV DNA and integrated HPV 16 in skin associated with vulvar malignant melanoma indicate that HPV may play a role in the development of vulvar malignant melanoma. The role of HPV could be either direct through infection of melanocytes or indirect as a cofactor with free radicals in chronic fibroinflammatory vulvar disorders such as lichen sclerosus.
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Affiliation(s)
- Angela Rohwedder
- Department of Microbiology and Virology, Albany Medical College, Albany, New York 12208, U.S.A
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