Burn scar cancer

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Arm of a patient with burn scar cancer that developed from a burn scar.
63-year-old patient with festering and ulcerating burn scar cancer of the scalp measuring 8 × 8 cm. At this point, when he was five years old, he suffered an electrical burn that never fully healed in his life.

As burn scars cancer , even burn scars carcinoma called it one after years or decades from designated burn scars resulting malignant tumor ( malignancy ) of the skin ( skin cancer ). Burn scar cancer is the most common type of scar cancer . In the English-language specialist literature, the term burn scar carcinoma is mostly used.

description

Burn scar cancer is a rare sequela of burns. The cancer may particularly arise when the burn scars of spontaneous healing left and not by the transplant with split skin were covered. In contrast, cases of burn scar cancer after a skin graft to treat a burn are extremely rare.

histology

In an analysis of 412 cases from 146 publications of burn scar cancer between 1923 and 2004, 71% of the cases were squamous cell carcinomas (spinaliomas). Basaliomas (12%), malignant melanomas (6%) and sarcomas (5%) were much less common . Other, rare tumor types were found in 4% of the cases. Mixed forms such as spinalioma-melanoma and spinalioma-basalioma were found in 1% each.

Incidence and latency

In the literature, incidence values ​​of 1 to 2% are given for burn scar carcinomas after corresponding burn injuries. Overall, patients with burn scars have only a slightly higher risk of developing skin cancer than the general population. Skin cancers are by far the most common cancer in humans. Burn scar carcinomas make up only a very small proportion of the total number of skin cancers. The cancer registry only records malignant melanoma of the skin cancers.

Several years or even decades usually pass from the complete healing of the causative burn to the initial diagnosis of burn scar cancer. Latency periods of 3 to 60 years are described in the literature . The mean age of the patients diagnosed with burn scar cancer is 50 years. The patients had the causative burn at an average age of 20 years. The mean latency period is 31 years. In about 5% of cases, the tumor forms at a point in time when the burn injury is still existing and has not healed.

treatment

Burn scar cancer is usually surgically removed by incision . This involves cutting into the surrounding healthy tissue with a safety margin of at least 20 mm. Squamous cell carcinomas in particular are highly aggressive, so that a radical resection that is as deep as possible is necessary. In cases in which a local incision is no longer possible, an amputation may be indicated , if this is feasible .

The recurrence rate is around 16%. In 22% of the cases, metastases are found in the surrounding lymph nodes . The need to remove the sentinel lymph node is controversial.

The mortality rate for burn scar cancer is around 21%.

  • MRI image of the burn scar carcinoma of the 63-year-old patient. The tumor infiltration in the skull and anterior cerebral cortex is clearly visible.

  • The transplanted skin flap of the arm on the left side of the head.

  • Relapse six weeks after tumor resection. Several satellite metastases can be seen around the transplanted skin flap .

  • Revision with deep tumor resection and closure of the surgical wound with a myocutaneous skin flap of the latissimus dorsi muscle .

Demarcation

Heat cancer is to be differentiated from burn scar cancer . In heat cancer, there are no burn scars, but rather through chronic erythema ab igne (Buschke heat melanosis) - after a very long latency period - squamous cell carcinoma. An example of heat cancer is kangri cancer .

Medical history

Jean-Nicolas Marjolin
Caesar Hawkins (1874)

The first descriptions of cancerous tumors that formed after burns date back to the 1st century AD.

In modern times, the Frenchman Jean-Nicolas Marjolin was the first to describe the "wart-like ulcer" in the first edition of the Dictionnaire de Medécine in 1828 , but not the malignant transformation of the ulcer into carcinoma. The transformation was first described by the British surgeon Caesar Hawkins (1798-1884). Other sources name the Irish surgeon Robert William Smith (1807–1873), who in 1850 described the connection between scar tissue, ulcer and metastasis. The term Marjolin ulcer was coined in 1903 by John Chalmers DaCosta (1863–1933) and includes burn scar cancer as well as others Scar cancer. In most cases (approx. 90%) the Marjolin ulcer is a burn scar carcinoma. In some publications, the term Marjolin ulcer is used synonymously with burn scar carcinoma.

further reading

  • KD Jashnani, VM Dhume, NK Bahal: Epithelioid sarcoma and squamous cell carcinoma arising in a burn scar. In: Indian journal of dermatology. Volume 56, Number 5, 2011, pp. 585-586, ISSN  1998-3611 . doi: 10.4103 / 0019-5154.87164 . PMID 22121287 . PMC 3221232 (free full text).
  • H. Kikuchi, T. Nishida et al. a .: Three cases of malignant melanoma arising on burn scars. In: The Journal of Dermatology . Volume 30, Number 8, 2003, pp. 617-624, ISSN  0385-2407 . PMID 12928532 . (Review).
  • PM Spring, JN Myers et al. a .: Malignant melanoma arising within a burn scar case report and review of the literature. In: The Annals of Otology, Rhinology, and Laryngology. Volume 110, Number 4, 2001, pp. 369-376, ISSN  0003-4894 . PMID 11307915 .
  • MD Alconchel, C. Olivares, R. Alvarez: Squamous cell carcinoma, malignant melanoma and malignant fibrous histiocytoma arising in burn scars. In: British Journal of Dermatology . Volume 137, Number 5, 1997, pp. 793-798, ISSN  0007-0963 . PMID 9415244 . (Review).
  • S. Castanares: Malignant degeneration in burn scars. In: California medicine. Volume 94, 1961, pp. 175-177, ISSN  0008-1264 . PMID 13691372 . PMC 1575778 (free full text).
  • N. Treves, GT Pack: The development of cancer in burn scars. In: Surg Gynecol Obstet. Volume 51, 1930, pp. 749-782.

Individual evidence

  1. ↑ a b R. E. Horch, GB Stark, JP Beier: Unusual explosive growth of a squamous cell carcinoma of the scalp after electrical burn injury and subsequent coverage by sequential free flap vascular connection - a case report. In: BMC Cancer . Volume 5, 2005, p. 150, ISSN  1471-2407 . doi: 10.1186 / 1471-2407-5-150 . PMID 16309562 . PMC 1314891 (free full text).
  2. ↑ Peter Reuter: Springer Lexicon Medicine. Springer, Berlin a. a. 2004, ISBN 3-540-20412-1 , p. 296.
  3. ↑ a b c d e Hans Lippert : Wundatlas: Compendium of complex wound treatment. 3rd edition, Georg Thieme Verlag, 2012, ISBN 3-13-157473-9 , p. 68. Restricted preview in the Google book search
  4. ↑ a b c L. G. Schnell, RR Danks: Massive Marjolin's ulcer in a burn graft site 46 years later. In: Journal of burn care & research. Volume 30, Number 3, 2009, pp. 533-535, ISSN  1559-047X . doi: 10.1097 / BCR.0b013e3181a28fa7 . PMID 19349873 .
  5. ^ A b c d A. Kowal-Vern, BK Criswell: Burn scar neoplasms: a literature review and statistical analysis. In: Burns . Volume 31, Number 4, June 2005, pp. 403-413, ISSN  0305-4179 . doi: 10.1016 / j.burns.2005.02.015 . PMID 15896501 . (Review).
  6. ^ SC Wallingford, CM Olsen et al. a .: Skin cancer arising in scars: a systematic review. In: Dermatologic Surgery . Volume 37, Number 9, September 2011, pp. 1239-1244, ISSN  1524-4725 . doi: 10.1111 / j.1524-4725.2011.02060.x . PMID 21635634 . PMC 3447738 (free full text). (Review).
  7. ^ Rolf-Markus Szeimies, Axel Hauschild, et al. (Ed.): Tumors of the skin. Georg Thieme Verlag, 2009, ISBN 3-13-158681-8 , S. V. limited preview in the Google book search
  8. ↑ Stiftung Warentest: skin cancer. dated April 20, 2012, accessed December 29, 2012
  9. ^ A b J. A. Petro, Z. Niazi: Burn Reconstruction. In: Jeffrey Weinzweig: Plastic Surgery Secrets Plus. Chapter 103, Elsevier Health Sciences, 2010, ISBN 0-323-08590-3 limited preview in Google Book Search
  10. ↑ MA Teli, NA Khan et al. a .: Recurrence pattern in squamous cell carcinoma of skin of lower extremities and abdominal wall (Kangri cancer) in Kashmir valley of Indian subcontinent: impact of various treatment modalities. In: Indian journal of dermatology. Volume 54, Number 4, 2009, pp. 342-346, ISSN  1998-3611 . doi: 10.4103 / 0019-5154.57610 . PMID 20101335 . PMC 2807710 (free full text).
  11. ^ I. Wani: Kangri cancer. In: Surgery . Volume 147, Number 4, April 2010, pp. 586-588, ISSN  1532-7361 . doi: 10.1016 / j.surg.2009.10.025 . PMID 19932909 .
  12. ↑ C. Ozek, R. Cankayali et al. a .: Marjolin's ulcers arising in burn scars. In: The Journal of burn care & rehabilitation. Volume 22, Number 6, 2001, pp. 384-389, ISSN  0273-8481 . PMID 11761388 .
  13. ↑ JN Marjolin: Ulcère. In: JN Marjolin: Dictionnaire de medecine 1828, p. 31.
  14. ↑ A. Sharma, RA Schwartz, KG Swan: Marjolin's warty ulcer. In: Journal of Surgical Oncology . Volume 103, Number 2, February 2011, pp. 193-195, ISSN  1096-9098 . doi: 10.1002 / jso.21783 . PMID 21259256 . (Review).
  15. ^ RW Smith: Observations upon the warty ulcer of Marjolin. In: Dublin quart J med Sci. Volume 9, 1850, pp. 257-274.
  16. ^ AH Cruickshank, E. Gaskell: Jean-Nicolas Marjolin: Destined to be Forgotten? In: Medical history. Volume 7, October 1963, pp. 383-384, ISSN  0025-7273 . PMID 14071961 . PMC 1034876 (free full text).
  17. ^ JC DaCosta: Carcinomatous changes in an area of ​​chronic ulceration or Marjolin's ulcer. In: Ann Surg . Volume 37, 1903, pp. 496-502.
  18. ↑ PL Chalya, JB Mabula et al. a .: Marjolin's ulcers at a university teaching hospital in Northwestern Tanzania: a retrospective review of 56 cases. In: World journal of surgical oncology. Volume 10, 2012, p. 38, ISSN  1477-7819 . doi: 10.1186 / 1477-7819-10-38 . PMID 22336561 . PMC 3292918 (free full text).
  19. ↑ CY Huang, CH Feng a. a .: Burn scar carcinoma. In: Journal of Dermatological Treatment . Volume 21, Number 6, November 2010, pp. 350-356, ISSN  1471-1753 . doi: 10.3109 / 09546630903386580 . PMID 20438387 .