Role of a Plastic Surgeon in the Management of Local Manifestations of Snakebite in a Tertiary Care Hospital: A Prospective Single-Center Case Series

Background  There is a paucity of literature regarding the management of snakebite site complications. The wound complications can have debilitating sequelae, most of which may require reconstruction. Methods  This is a prospective single-institution observational study conducted from November 2019 to December 2021. Patient demographic characteristics and snakebite-related information, length of hospitalization, surgical lesions encountered, the type of treatment offered, and complications were recorded. Results  Fifteen patients (10 males and 5 females) with ages ranging from 10 to 53 years (mean: 36.5 years) were included in the study. Urgent fasciotomy was performed in three patients with compartment syndrome of the upper limb. Facial reconstruction was performed in one patient. One patient required distraction, cross-finger flap, and bone grafting of the index finger, while another patient required a pedicled groin flap for digital salvage. Below knee amputation was done for Marjolin's ulcer in a chronic snakebite case. Few patients required skin grafting. No major complications were encountered. Conclusions  Plastic surgeons play an important role in the management of bite site effects for restoration of form and function, which goes a long way in rehabilitating these patients back in the society. This case series presents a varied range of bite site complications and their management that would serve as a guide to plastic surgeons for better outcome.

A case report: Management dilemma in a large fungating squamous cell carcinoma over a Marjolin's ulcer on the chest wall coexisting with severe post burn contracture of the neck

INTRODUCTION AND IMPORTANCE

Marjolin's ulcer is a premalignant condition occurring over scars and chronically inflamed tissue. Squamous cell carcinoma is the most common malignancy associated with Marjolin's ulcer. These are rare tumors which spread locally and once infiltrating, may lead to distant spread. In our case recurrent bleeding causing severe anaemia and foul smelling discharge, mandated an early resection, the problem in this case was due to his chest condition and severe post-burn neck contracture and he was unfit for general anesthesia. He was subjected to serial local excisions as well as subsequent serial skin grafts.

CASE PRESENTATION

We present a case of a large fungating squamous cell carcinoma in a patent having burn scar over his chest as well has having post-burn contracture of the neck, posing problems in management due to intubation issues.

DISCUSSION

The progression of disease and metastasis is relatively slow due to scarring and meager lymphatic and vascular supply over these scars. Owing to the complexities and urgency, we managed him unconventionally with serial excision under local anesthesia and skin grafting of the wound.

CONCLUSION

Some alterations in management may be a gift of life in such patients is the message through this case.

Pilonidal sinus disease carcinoma: Survival and recurrence analysis

BACKGROUND

The study aims to determine the survival and recurrence rates of pilonidal sinus disease (PSD) carcinoma.

METHODS

The data were collected retrospectively by searching the worldwide literature for all reports of carcinoma developing on the background of PSD. The results were presented using Kaplan-Meier curves.

RESULTS

Between 1900 and 2022, 140 cases of PSD carcinoma were published in 103 papers, with follow-up data available in 111 cases. Squamous cell carcinoma constituted 94.6% of the cases (n = 105). The disease-specific survival rate was 61.7% for 3 years, 59.8% for 5 years, and 53.2% for 10 years. There was a significant survival difference between stages: 80.0% in stages I and II, 70.8% in stage III, and 47.8% in stage IV (p = 0.01). The 5-year survival in G1-tumors was better than G2 and G3-tumors at 70.5% and 32.0%, respectively (p = 0.002). Recurrence occurred in 46.6% of the patients. The time-to-recurrence in patients treated with curative intention averaged 15.1 months (1-132 months). Local, regional, and distant recurrence was observed in 75.6%, 33.3%, and 28.9% of the recurrent tumors, respectively.

CONCLUSIONS

Pilonidal sinus carcinoma has a worse prognosis than primary cutaneous squamous cell carcinoma. Poor prognostic factors include advanced-stage disease and poor differentiation.

Management of Marjolin's ulcer with popliteal lymphadenopathy with surgical resection and lymphadenectomy in a young patient, an uncommon lesion and overlooked entity: A case report

Key Clinical Message

In non-healing ulcers with a previous history of burns, clinicians should have a high index of suspicion for Marjolin's ulcer and a low threshold for biopsy, irrespective of age.

Abstract

Marjolin's ulcer is a rare malignancy arising from chronic inflammation and commonly manifests in burn scars. Thus, in cases of chronic wounds or non-healing ulcers, health professionals should have a high index of suspicion and a low threshold for biopsy, irrespective of age. Early diagnosis and timely management of tumors can improve the prognosis and overall survival rate. Moreover, further studies are needed to develop an evidence-based management approach for Marjolin's ulcer.

Squamous cell carcinoma complicating chronic osteomyelitis: A systematic review and case series

INTRODUCTION

Squamous cell carcinoma (SCC) is a rare but serious complication of chronic osteomyelitis. This study aimed to determine an optimum approach to diagnosis and management.

METHODS

A systematic review was performed using Medline, Embase, CINAHL and Web of Science, from 1999-present. Additional cases, meeting the eligibility criteria, were added from our hospital database. Patient demographics (age, gender, co-morbidities), osteomyelitis diagnosis (location, duration), diagnosis of SCC (method, imaging, extent of disease) and management (amputation versus wide local excision versus palliation) as well as outcome at one and five years were collected.

RESULTS

Nineteen studies involving 106 patients met strict inclusion criteria. All published studies were case reports or case series. Chronic osteomyelitis had been present for a mean of 31 years (range 3-67) prior to SCC diagnosis. SCC was most commonly treated by amputation (81%). A poorer outcome occurred in those with metastatic disease (p = 0.006 at one year; p = 0.032 at five years), an incidental diagnosis at surgery for osteomyelitis (p = 0.052; p = 0.021) and SCC after pelvic osteomyelitis (p < 0.001; p = 0.002).

CONCLUSIONS

SCC should be suspected in all cases of chronic osteomyelitis with skin changes, particularly if the duration of sinus drainage exceeds 3 years. Histological biopsy for malignancy should be taken in all suspected cases, as well as routinely during excision of osteomyelitis when chronic skin changes are present. Staging computed tomography (CT) scanning is recommended to guide adjunctive therapy. Amputation, where possible, may be considered as the definitive surgical management, after discussion with the patient.

Post-burn scar malignancy: 5-year management review and experience

The study spotlights a severe uncommon post‐burn complication, Marjolin's ulcer, in upper Egypt plastic and wound care centres. This problem is mainly related to inadequate medical care and awareness. No community or race is immune. The underlying malignant transformation mechanism remains unclear. The study aims, according to our experience, to review the prognostic factors through the management protocol of Marjolin's ulcers. This prospective study was conducted in the Aswan University Plastic & Burn surgery department in South Egypt between 2013 and 2020 and investigated 226 patients with chronic post‐burn ulceration. Nineteen cases were proved to have Marjolin's ulcer, and the other cases that had been excluded from being malignant went for reconstruction with split‐thickness skin graft with/without flap after adequate ulcer debridement. The surgical, oncologic, radiologic indications, and prognostic factors were reviewed according to our management outcome—the assessment with follow‐up period extended over 5 years. Histopathology of ulcers ranged among mild, moderate, and poorly differentiated squamous cell carcinoma. One scalp ulcer case showed basosquamous pathology. Most cases presented at age above 50, but no age was immune. The mean latent period was 29 years on average. The lesions' sites varied in their anatomic location where they involved the upper extremity, the scalp, and the lower extremity that had a predilection. Although surgical excision is the primary management line for tumour ablation, other factors may change the management course. During the follow‐up period, neoplasm recurrence in the form of lymph node enlargement and/or locoregional metastasis was detected in eight cases. Within 1 year after the intervention, six recurrent cases died, and two were saved. In addition to the case study, this paper reviewed the literature and provided our team a good experience in light of the NCCN protocol for non‐melanotic cutaneous carcinoma, although we suffered limited medical resources. It is concluded that early accurate diagnosis, low‐grade malignancy, and well‐planned individualised surgery with adjuvant radiotherapy were the best prognostic factors. The close follow‐up for an early sign of disease recurrence is paramount.

When Benign Becomes Cancer: Malignant Degeneration of Chronic Inflammation

Chronic inflammation, long implicated in the genesis of malignancy, is now understood to underlie an estimated 25% of all cancers. The most pertinent malignancies, to the plastic surgeon, associated with the degeneration of chronic inflammation include Marjolin's ulcer, breast implant-associated large cell lymphoma, radiation-induced sarcoma, and Kaposi's sarcoma. The cellular and genetic damage incurred by a prolonged inflammatory reaction is controlled by an increasingly understood cytokinetic system. Advances in understanding the chronic inflammatory cascade have yielded new therapeutics and therapeutic targets.

Squamous cell carcinoma arising from an ischial pressure ulcer initially suspected to be necrotizing soft tissue infection: A case report

BACKGROUND

Pressure ulcers are the most common complications in bedridden patients or those with spinal cord injuries. Marjolin's ulcer refers to a malignant transformation arising from burn scars or chronic nonhealing wounds-such as pressure ulcers-over many years. Squamous cell carcinoma is the major histopathologic type of Marjolin's ulcer, and the gold standard for diagnosis is tissue biopsy. Medical professionals may have difficulty distinguishing pressure ulcers from Marjolin's ulcer, especially when the latter presents with invasive infections. Thus, malignant transformations arising from pressure ulcers are frequently overlooked. Herein, we describe a case of squamous cell carcinoma arising from pressure ulcers on the left ischium, which was initially identified as a necrotizing soft tissue infection.

CASE REPORT

A 59-year-old paraplegic patient presented with stage 3 left ischial pressure ulcer, which involves full-thickness skin loss and extends into deep subcutaneous tissue, and arrived at our hospital with suspected sepsis. Upon physical examination, the patient presented with fever and shivering. Initial examination and imaging findings revealed the presence of necrotizing soft tissue infections. Three weeks later, rapid increase in granulation in the deep part of the ulcer was observed. Samples from multiples ulcer sites were collected for tissue biopsy. Finally, histological examination revealed well-differentiated squamous cell carcinoma. The patient received radiation therapy and chemotherapy and died 11 months after the diagnosis.

CONCLUSION

Malignant transformations arising from pressure ulcers may closely resemble pressure ulcer infections. In these cases, tissue biopsies should be performed during primary care for the infection to exclude malignant transformations.

Acute Marjolin's Ulcer in Chronic Foot Wounds with Previous Negative Biopsy: Report of Two Cases

Marjolin’s ulcer is a rare and often overlooked diagnosis which can be encountered by a variety of specialities. Majority of the literatures describe long latency period of 11 to 75 years. The authors present two unusual cases of rapid progression to Marjolin’s ulcer in patients with previously negative biopsy 8- and 10-month prior. This highlights the importance for clinicians to have a high degree of suspicion when encountered with any non-healing wound, especially one who’s symptomatology and morphological features have undergone an acute change. Even with previous negative biopsy, patients should still be followed-up closely and clinicians should not hesitate to perform re-biopsy if the suspicion arises.

[Diagnostic pitfall: Early arising, multiple and recurrent Marjolin's ulcer. About 8 patients (16 tumors) and literature review]

INTRODUCTION

Marjolin's ulcer (MU) is a large entity representing skin cancers resulting from the transformation of chronic wounds of a heterogeneous nature. Burn scars are the most at risk of degeneration, in particular because there are the sites of important skin tension. Atypical forms are not uncommon. The objective of this study is to present these exceptions which are underestimated.

MATERIALS AND METHODS

All patients with UM in our centre between January 2011 and February 2019 have been included permitting to report the initial pathology, the location, the latency time, the histology and the management carried out.

RESULTS

Eight patients were treated in our center for MU, they developed 16 skin cancers. Fourteen were squamous cell carcinomas (SCC). The shortest latency period was 2 months. The youngest patient was 22 years old when she was diagnosed with MU. Three patients had at least 2 synchronous SCC. One patient had a recurrence after a split-thickness skin grafting on artificial dermis and 2 patients had second locations.

CONCLUSION

Atypic forms are not rare. MU is commonly recurrent, multiple, early arising and may appear in young people. The treatment of chronic wounds cannot be dissociated from the treatment of contractures, otherwise the wound will inevitably reappear.

Clinical features and treatment of 140 cases of Marjolin's ulcer at a major burn center in southwest China

Marjolin's ulcer is a type of malignant tumor that occurs in scar tissue. The present study aimed to summarize and analyze the aetiology, clinical characteristics, treatment methods, metastasis and prognosis of this disease. A total of 140 cases of Marjolin's ulcer encountered at the Institute of Burn Research, Southwest Hospital (Chongqing, China) between January 2013 and December 2017 were retrospectively analyzed. Demographic data, clinical characteristics, occurrence of bone invasion and lymph node metastasis, as well as treatment and prognosis were statistically analyzed. Among the 140 patients, the initial injury or primary disease occurred at 1–75 years of age, while Marjolin's ulcer occurred at 15–85 years of age (mean, 53.3±1.2 years). The mean latency period was 28.8±1.7 years. The most common initial injury of the patients was flame burns, followed by skin masses, trauma, skin ulcerations caused by repeated scratching/friction, and scalding. The age at onset of initial injury or disease in patients had a significantly negative correlation with the latency period (P<0.01). The most common lesion locations were the lower limbs (42.1%), followed by the head, face and neck (34.5%). Of the 140 patients, 46 cases (32.9%) had bone invasion, 33 cases (23.6%) had lymph node enlargement and only 5 cases (3.6%) had lymph node metastasis. The skull was the bone that was most susceptible to Marjolin's ulcer invasion. The prevalence of bone invasion in patients with head, face and neck lesions was significantly higher than that in patients with lesions in other locations (P<0.01). The surgical methods applied were skin grafting, local flap repair, amputation and island flap repair. In the 65 cases who underwent follow-up, recurrence mainly occurred within 1 year after surgery. In conclusion, Marjolin's ulcer mainly occurred in males and was a scar carcinoma after a flame burn in most cases. Autologous skin grafting and local skin flap repair were the major repair methods. The peak period of recurrence was within one year after surgery and patients should receive regular follow-ups.

A review of 31 cases of Marjolin's ulcer on scalp: Is it necessary to preventively remove the scar?

We aimed to report the clinical features of squamous cell carcinoma (SCC) occurring on scalp scar tissue among a Chinese population, demonstrate its pathological progress, analyse the prognosis-related factors, and share our clinical experience of managing this rare disease in practice. A retrospective study was conducted at West China Hospital from January 2013 to January 2018 aiming to identify patients with a diagnosis of SCC or squamous atypical hyperplasia arising from scalp scars. Their medical records were reviewed, and related data were retrieved. Follow up was conducted, and informed consent was obtained by phone calls in June 2018. Of the 31 scalp Marjolin's ulcer (MU) patients, the average latency period and post-ulceration period were 42.9 years and 37.5 months, respectively. Among them, 30 patients (97%) were diagnosed with cancer more than 5 years after initial injury, and 25 patients (80.7%) experienced a pre-ulceration period longer than 20 years. A negative correlation between scalp MU's post-ulceration period and its pre-ulceration period was identified. Only burn scars caused post-ulceration periods of more than 24 months (7/19). Incomplete healing wounds experienced a significantly shorter latency period (P = 0.004) and longer post-ulceration period than others (P < 0.0001). However, the depth of tumour infiltration and complete tumour resection were the only two independent factors that significantly dictated patients' survival in this study. In conclusion, the scalp scaring tissue experienced a long-term stable period but would transform to malignancy rapidly and progressively once ulceration formed. The underlying malignant transformation mechanism remains unclear. Thus, we recommend scalp scarring tissue to be radically removed.

Squamous Cell Carcinoma From Marjolin's Ulcer of the Foot in a Diabetic Patient: Case Study

Squamous cell carcinoma (SCC) has been commonly reported by foot and ankle specialists. Marjolin's ulcer is a malignancy that involves a posttraumatic scar or ulceration that can develop into SCC from chronic neuropathic pedal wounds, venous stasis, or decubitus ulcerations. Most Marjolin's ulcers are found in the lower extremity, specifically the feet, and it is twice as common in females as males. Biopsy of the tumor is the reference standard to diagnose SCC, and wide excision of SCC is the most common treatment option. The present case study describes an 83-year-old diabetic wheelchair-bound female who presented to the wound care clinic with a right heel nonhealing pressure ulceration. After biopsy and surgical excision, the patient was found to have SCC. This case was followed up for 5 years in which the patient had successful excision of the tumor with no recurrence. The clinical significance of our case study is to assist in the diagnosis, management, and prognosis of patients with SCC. In addition, this study has shown that adequate excision of the tumor margins and depth is necessary to prevent potential recurrence and metastasis.

Post-burn spontaneous brain fungation caused by infiltrating Marjolin's ulcer of scalp

Marjolin's ulcer is a well-recognized, rare, long-term complication of post-burn scar and other chronically irritating local skin conditions. Its infiltration into the skull bones and the underlying dura causing complete destruction is very rare and quiet exceptional. We present an unusual case of spontaneous brain fungation through the scar tissue present over the scalp as a result of flame burn 18 years back. Patient was treated surgically, but expired after 10 days. Though we were not able to save the patient, its presentation was so unique that we want to report this case.

Old War Scar Revisited

In 1828, Jean Nicholas Marjolin, a French surgeon, first described the findings of a neoplastic development arising from a burn scar, now more commonly referred to as a Marjolin's ulcer. A Marjolin's ulcer describes malignant degeneration in any chronic wound. The majority of cases arises in burn scars and are often latent for decades. Marjolin ulcers have been widely identified in post-war time injuries. These ulcers may arise in almost any anatomical location. We report a case of an 82-year-old male that presented with a painful fluctuating mass on the right arm localized to the site of an old grenade blast injury he sustained many years earlier. While the presentation of these cases may be variable, the significance of proper management of the wounds is essential to optimal patient outcomes. An aggressive course and poor prognosis is associated with Marjolin's ulcers that degenerate into squamous cell carcinoma. Early detection and aggressive treatment/management with wide local excision and prompt coverage yield the best results when treating patients with Marjolin's ulcers.

Clinical characteristics and therapeutic analysis of 51 patients with Marjolin's ulcers

Marjolin's ulcers, which are epidermoid carcinomas arising on non-healing scar tissue, may be of various pathological types, including squamous cell carcinoma. The pathogenesis of squamous cell carcinoma arising in an ulcer differs from that of the primary cutaneous squamous cell carcinoma. This squamous cell carcinoma is aggressive in nature, and has a high rate of metastasis. Between January 2001 and September 2013, 51 patients with Marjolin's ulcers were admitted to the Departments of Plastic Surgery of the Affiliated Foshan Hospital and the Second Affiliated Hospital of Sun Yat-sen University. The ulcers included 43 cases of squamous cell carcinoma, six of melanoma, one of basal cell carcinoma and one of epithelioid sarcoma. The clinical data of these patients were retrospectively analyzed. Patients were followed until mortality. Among the patients with squamous cell carcinoma, 30.23% exhibited sentinel lymph node metastasis and 11.63% had distant metastasis. Among the patients with melanoma, 66.67% had sentinel lymph node metastasis and 33.33% had distant metastasis. Sentinel lymph node metastasis was successfully detected in 11 patients with Marjolin's ulcer using ¹⁸F-fluorodeoxyglucose positron emission tomography-computed tomography and B-mode ultrasound guided biopsy. Squamous cell carcinoma was often treated by extended resection and skin grafting or skin flap repair. Patients with deep, aggressive squamous cell carcinoma of an extremity and sentinel lymph node metastasis underwent amputation and lymph node dissection. This treatment was also used for melanoma type Marjolin's ulcers.

[Marjolin's ulcer. A 10 year experience in a diabetic foot unit]

BACKGROUND

Marjolin's ulcer is defined as the appearance of a neoplasm within a chronic wound. The most common histological type is squamous. A total of 2 cases treated in our hospital are presented.

CLINICAL CASE

Case 1. A 71 year old man who presented with redness and suppuration from the wounds he had in his right foot after an electric shock 40 years earlier. The radiology showed involvement of the 4° and 5° metatarsal. Supracondylar amputation was performed, showing a well-differentiated invasive squamous cell carcinoma.

CASE 2

A 56 year old male, paraplegic for 20 years. He was treated due to an infected right heel ulcer, with partial improvement, but the ulcers persisted. Biopsy was performed, reporting as epidermoid carcinoma. Infracondylar amputation was performed. The diagnosis was a well-differentiated squamous cell carcinoma infiltrating the dermis.

CONCLUSION

The prevalence of Marjolin's ulcer is 1.3-2.2% of all ulcers. Diagnosis is difficult, so biopsy is recommended on any suspicious lesion or ulcer that has received conservative treatment for one month without improvement, although this time limit is not clear. The treatment is the surgery. Local excision with a margin of an inch is enough. If the ulcer is extensive, amputation is required. Survival is estimated between 66 and 80% at 2 years, with recurrence rates of 23%. Unfavourable factors are poor tumour differentiation and metástasis, appearing in 20% of cases.

A Retrospective Study of Marjolin's Ulcer Over an Eleven Year Period

Background:

Marjolin's ulcer is a rare aggressive cutaneous malignancy occurring in previously occurred wounds. The most common aetiology is a burn wound involving extremities and squamous cell carcinoma is the most common variant.

Materials and Methods:

A retrospective analyses of medical records of patients treated in a single unit with a diagnosis of Marjolin's ulcer was performed.

Results:

During the study period, 14 patients were treated. Four patients had lymph node metastases and one had pulmonary metastases at the time of presentation. Seven patients underwent wide excision with reconstruction and seven underwent amputation or disarticulation because of advanced malignancy. During the follow up two patients developed local recurrence and one developed pulmonary metastases. Both the patients with pulmonary metastases had Marjolin's ulcer of trunk.

Conclusion:

Marjolin's ulcer occurs more commonly in the extremities. Distant metastases occur commonly in patients with ulcers on the of trunk.

Marjolin's ulcer: clinical and pathologic features of 83 cases and review of literature

BACKGROUND

Marjolin's ulcer is a rare, aggressive condition that arises on chronic skin lesions and diseases. Inthis article, we will report 83 cases of this disease.

METHODS

Retrospectively, we retrieved 83 records of patients with cancer arising from chronic skin conditions.Data concerning demography, type of original skin insult, time interval between original lesion and cancer,cancer histology, and lymph node involvement were recorded.

RESULTS

The mean age was 55.30 years (range: 21-90). There were 51 males (61.5%) and 32 females (38.5%).Foot was the most prevalent site of primary skin lesion (49.4%) followed by scalp (15.6%). Original skin insultswere burn (87.9%), osteomyelitis (2.4%), radiation (2.4%), electrical burn (1.2%), surgical scar (2.4%),pemphigus (1.2%), bite (1.2%), and bed sore (1.2%). Histologic diagnosis were well differentiated SCC(38.6%), SCC, differentiation not reported (24.1%), moderately differentiated SCC (13.2%), BCC (9.6%), poorlydifferentiated SCC (6.0%), melanoma (2.4%), verrucous carcinoma (2.4%), MFH (1.2%), mucoepidermoidcarcinoma (1.2%), and leiomyosarcoma (1.2%). Most of the cases occurred more than 20 years after the initialskin insult. There were 6 (7.2%) cases that developed within 1 year (acute Marjolin's Ulcer). Forty three patients(69.3%) had palpable regional lymph nodes.

CONCLUSION

Data in this series were in confirmation with many other reports. Marjoln's ulcer should be consideredas a significant post-skin injury complication.

Ten years of experience in chronic ulcers and malignant transformation

Malignant degeneration of wounds is rare and often misdiagnosed. Delay in diagnosis may result in a worse prognosis. The aim of this study is to determine the number of skin cancers associated with chronic skin ulcers in our facility over a period of 10 years. Between January 2002 and December 2012, a total of about 1000 patients had consulted with us for chronic wounds, especially of vascular, diabetic and traumatic origin and pressure ulcers. Thirteen skin cancers had been detected: seven squamous cell and five basal cell carcinomas and one melanoma. We highlight how important it is to be aware of the signs suggesting a malignant change and the importance of biopsy at regular intervals during the life cycle of any chronic wound.

Malignancy in chronic burn scar: a 20 year experience in Mosul-Iraq

BACKGROUND

Marjolin's ulcer, a term used to describe a malignancy arising in chronic ulcers of the skin, sinuses, scar tissue, and especially burns scars. The majority of burn scar carcinomas are seen after a lag period in burns that were not grafted following injury.

OBJECTIVE

To describe the epidemiology and its clinical characteristics of patients with Marjolin's ulcer arising in a chronic burn scar.

DESIGN AND PATIENTS

A case series study was done at Al-Jumhoori Teaching Hospital Burn Center, identifying 27 patients with chronic burn scar that underwent malignant transformation into a carcinoma, from January 1992 to December 2011. Data related to patients were retrieved from their medical records. All lesions were secondary to burns from various causes. All patients were proven to have malignancy by biopsy.

RESULTS

Of the 27 Marjolin's ulcer patients, 18 were males and 9 were female (male to female ratio 2:1), and the mean age was 42.7 years (range: 18-80 years). Upon histological examination, all were diagnosed as well-differentiated squamous cell carcinoma. The lower limb was most frequently affected (81.5%). Treatment of the neoplasm consisted of excision and grafting in 81.5%, radiotherapy in 11.1% and amputation in 7.4%. Local recurrence was noted in 22.2%, and lymph node metastasis in 11.1%.

CONCLUSION

Chronic ulcer that undergoes malignant change was a common finding in the present study. All suspected masses or ulcers within chronic burn scars should be promptly biopsied.