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. (C) 2013 Elsevier Ltd and ISBI. All rights reserved.