A shorter lag period of mesenchymal malignancy on Marjolin's ulcer

Çeli̇köz, Bahatti̇n; Demiriz, Murat; Selmanpakoğlu, Naki

doi:10.1016/s0305-4179(96)00026-5

Cited by 26 publications

(28 citation statements)

References 7 publications

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“…3 Last, miscellaneous factors, such as irritation, poor lymphatic regeneration, antibodies, DNA mutations, and local toxins, have also been incriminated. 23 Most authors agree that prolonged healing of severe burn wounds (and therefore chronically abnormal keratinocyte cell biological activity) is the major potential risk factor for the development of scar carcinoma. 8,9 TYPES Two main types of Marjolin's ulcer have been described: acute and chronic.…”

Section: Pathogenesismentioning

confidence: 99%

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Marjolin’s Ulcer: A Preventable Complication of Burns?

Copçu

2009

Plastic and Reconstructive Surgery

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Marjolin's ulcer is a rare and aggressive cutaneous malignancy that arises on previously traumatized and chronically inflamed skin, especially after burns. This clinical condition was first described by Marjolin in 1828. The term "Marjolin's ulcer" has been generally accepted to refer to a long-term malignant complication of the scars resulting from burns. However, vaccination, snake bites, osteomyelitis, pilonidal abscesses, pressure sores, and venous stasis may also induce this tumor. Clinically, reports suggest that atrophic and unstable scars tend to develop into cancer. Various etiological factors have been implicated in the condition, including toxins released from damaged tissues, immunologic factors, cocarcinogens, and miscellaneous factors such as irritation, poor lymphatic regeneration, antibodies, mutations, and local toxins. The incidence of burn scars undergoing malignant transformation has been reported to be 0.77 to 2 percent. All parts of the body can be affected, but the extremities and the scalp are most frequently affected. There are two variants: acute and chronic. In the former, the carcinoma occurs within 1 year of the injury. The chronic form is more frequent and malignancy tends to develop slowly, with an average time to malignant transformation of 35 years. Although many different cell types can be seen in these lesions, the major histological type is squamous cell carcinoma. Marjolin's ulcers are generally considered as very aggressive tumors with a higher rate of regional metastases; radical excision is the treatment of choice, but there is no consensus on lymph node dissection. Marjolin's ulcer can be insidious and often leads to a poor prognosis, and deaths from Marjolin's ulcer are not uncommon. Meticulous wound care is a crucial step in prevention of these lesions.

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Section: Pathogenesismentioning

confidence: 99%

“…1,4,6,9,14,23,26 The lag period before induction of malignancy is inversely proportional to patient's age at the time of burn injury. 4 Thus, younger patients tend to develop cancer after a much longer period of time.…”

Section: Latent Periodmentioning

confidence: 99%

Marjolin’s Ulcer: A Preventable Complication of Burns?

Copçu

2009

Plastic and Reconstructive Surgery

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“…In the previous literature, 24 cases of burn scar sarcomas have been reported. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Of 24 cases, only 1 case of dermatofibrosarcoma protuberans (DFSP) has been reported. 19 We encountered a second case of DFSP arising in a chronic, severe burn scar, which we present herein.…”

mentioning

confidence: 99%

Dermatofibrosarcoma Protuberans Arising From a Burn Scar of the Axilla

Tanaka

Hatoko²,

Tada³

et al. 2004

Annals of Plastic Surgery

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It is well-known that the development of a malignant tumor in a chronic burn scar is one of the long-term complications of a severe burn. Most of these tumors are squamous cell carcinomas, and sarcomas are much rarely seen in chronic burn scars. In the previous literature, 24 cases of burn scar sarcomas were reported. The authors report the second case of dermatofibrosarcoma protuberans arising in a chronic, severe burn scar. A 68-year-old woman with a reddish tumor in the right axilla was referred to the authors' hospital. The patient had sustained severe burns in the right axilla, upper arm, and trunk at the age of 6 years. A biopsy specimen revealed dermatofibrosarcoma protuberans. There was no evidence of distant metastasis. The tumor was excised widely to include the surrounding burn scar. Two years after the operation, there was no evidence of tumor recurrence. As surgeons, we should recognize the possibility of the occurrence of various malignant tumors including sarcomas on burn scars.

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“…Factors believed to contribute to the development of malignancy include release of local toxins following injury, poor lymphatic regeneration in scars, chronic irritation, and existence of multiple dividing cells which are susceptible to mutations [14]. Somatic mutations of the Fas (Apo-1/ CD-95) gene and deletions of the p53 oncogene have been suggested to be predisposing factors in the development of Marjolin's ulcer, but most patients have no genetic predisposition [15,16].…”

Section: Discussionmentioning

confidence: 99%

Development of Marjolin’s ulcer within one month of burn injury with synchronous primary lung squamous cell carcinoma in an elderly patient: report of a case with allelotyping

2010

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Marjolin's ulcer defines the occurrence of malignancy, usually squamous cell carcinoma, in the setting of a post-traumatic scar often following thermal injury. The latency period from the time of injury to the onset of malignant transformation averages 30 years with the earliest documented incidence occurring 6 weeks after injury. In addition, the occurrence of multiple primary malignancies is a rare event. To our knowledge, we report the first case in the literature of a well-differentiated squamous cell carcinoma developing within 1 month of thermal injury to an elderly patient's right index finger with an incidental synchronous primary lung moderately differentiated squamous cell carcinoma that was morphologically and genetically different as confirmed by allelotyping. There is scant precedent literature on acute Marjolin's ulcers, and the most acute cases have arisen 6 weeks post-burn. There is also little published literature on the incidence of multiple primary malignancies. The quoted incidence of this event is <1%. Clinicians should be aware of the possibility of malignant transformation at the site of prior thermal injury. Biopsy remains the gold standard for diagnosis for Marjolin's ulcer. MRI is the most important diagnostic imaging tool because it will demonstrate the margins and extent of the lesion. Due to the aggressive nature of Marjolin's ulcer, treatment is usually surgical and dependent upon grading. When multiple lesions are detected after staging of a presumed neoplasm, the possibility of multiple primary maligancies should be considered. Allelotyping is a process that can be utilized to determine if multiple masses are related.

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A shorter lag period of mesenchymal malignancy on Marjolin's ulcer

Cited by 26 publications

References 7 publications

Marjolin’s Ulcer: A Preventable Complication of Burns?

Marjolin’s Ulcer: A Preventable Complication of Burns?

Dermatofibrosarcoma Protuberans Arising From a Burn Scar of the Axilla

Development of Marjolin’s ulcer within one month of burn injury with synchronous primary lung squamous cell carcinoma in an elderly patient: report of a case with allelotyping

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