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 Table of Contents  
Year : 2020  |  Volume : 15  |  Issue : 2  |  Page : 330-332

Squamous cell carcinoma (Epithelioma) in postburn scar over foot

1 Department of General Surgery, JNMC, DMIMS, Wardha, Maharashtra, India
2 Department of General Surgery, JNMC, Wardha, Maharashtra, India

Date of Submission02-Jun-2018
Date of Acceptance23-Aug-2019
Date of Web Publication21-Dec-2020

Correspondence Address:
Dr. Sandip Shinde
Department of General Surgery, JNMC, Sawangi, Meghe, Wardha, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jdmimsu.jdmimsu_42_18

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Squamous cell carcinoma arising from burn scar of 20 years is rare. Here, we present a case of a 50-year-old female with ulceroproliferative lesion over heel and dorsum of foot following thermal burn sustained 20 years ago. The patient was not willing for surgical debridement and skin grafting following which he went into septicemia and ultimately landed into below-knee amputation without any adjuvant therapy. Post amputation, the patient survived for 5 years.

Keywords: Amputation, postburn, seizures, septicemia, squamous cell carcinoma

How to cite this article:
Chandak SS, Shinde S, Rathod P. Squamous cell carcinoma (Epithelioma) in postburn scar over foot. J Datta Meghe Inst Med Sci Univ 2020;15:330-2

How to cite this URL:
Chandak SS, Shinde S, Rathod P. Squamous cell carcinoma (Epithelioma) in postburn scar over foot. J Datta Meghe Inst Med Sci Univ [serial online] 2020 [cited 2021 Jan 19];15:330-2. Available from: http://www.journaldmims.com/text.asp?2020/15/2/330/304262

  Introduction Top

Malignant degeneration of postburned lesions and scars is an inevitable eventuality, afflicting at least 0.77%–2% of the deep burns that had been allowed to heal by secondary intention, those which never healed completely and the unstable postburned scars that frequently ulcerate on trivial traumatic insults of daily life activities.[1],[2],[3] Celsus After Christ (AC) deserves acknowledgment for his earliest recognition of this phenomenon in the first century time Anno Domini (AD).[4] Later on in 1828, the French physician Marjolin JN etiologically classified ulcers as those due to “local” causes and those secondary to “internal” causes; however, he could not specifically recognize the malignant potential of these lesions.[5],[6] Dupuytren,[7] in 1839, provided a full description of a case of amputation for a cancer in a patient who had suffered a sulfuric acid burn injury. Da Costa,[8] in 1903, was the first to coin the term “Marjolin's ulcer” (MU) to describe malignant degeneration of skin scars particularly the postburned scars.

Not surprisingly, MUs can emanate from any chronic wound or unhealed scar; however, the neglected burn wounds constitute their most common seats of origin.[9],[10],[11] The following review focuses on the epidemiological and clinical details of MU emanating in the aftermath of burn injuries with a view to provide a comprehensive summary of the key conceptual issues and recent updates on the management for those who happen to be the frontline care providers for the patients with MU.

Epidemiologic considerations

Whereas 0.77%–2% of the postburned wounds and scars are reported to undergo malignant degeneration,[3] overall the postburned wounds and scars contribute to 2% of all squamous cell carcinomas (SCCs) and 0.03% of all basal cell carcinomas of the skin.[4] MU is relatively commoner among males than females.[12],[13],[14],[15] The exact explanation for this is not yet known; however, more frequent initial burn trauma among males as well as their more prolonged exposure to sunlight are some of the possible contributors to this higher frequency of MU among males. No age is immune to MU with individuals from almost all age groups, including children being afflicted worldwide.[1],[2],[3],[4],[5] MU has been reported among the individuals of all races.[16],[17],[18]

  Case Report Top

A 50-year-old female presented with an ulceroproliferative lesion over the heel and dorsum of the foot with foul smell and evidence of anemia and septicemia [Figure 1]. This patient also had a history of epilepsy since childhood and was on antiepileptic drugs for the same. On clinical examination, there was no regional lymphadenopathy. X-ray chest and other investigations except complete blood count were found to be within the normal limits.
Figure 1: Nonhealing ulcer over foot (squamous cell carcinoma)

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Wedge biopsy was taken under local anesthesia and sent for histopathology of which the reports came out as SCC. During this period, the anemia and septicemia was corrected with higher antibiotics and blood transfusion. Once the patient was hemodynamically stable definitive treatment was given as below-knee amputation [Figure 2].
Figure 2: Below-knee amputation

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The patient was discharged after 2 weeks and survived for more than 5 years without any adjuvant chemotherapy or radiotherapy [Figure 3].
Figure 3: Amputated stump scar is healthy

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This case is being reported for its rarity, i.e., postburn scar following seizures over period of two decades [Figure 1], [Figure 2], [Figure 3].

  Conclusion Top

MU is a largely preventable dreadful menace of considerable morbidity and mortality. Although over the years, significant progress has been made in managing MU, the key to successful eradication lies in prevention by ensuring adequate surgical care (with early excision and grafting) of the deep burns in their acute phase.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Copcu E. Marjolin's ulcer: A preventable complication of burns? Plast Reconstr Surg 2009;124:156e-64e.  Back to cited text no. 1
Kowal-Vern A, Criswell BK. Burn scar neoplasms: A literature review and statistical analysis. Burns 2005;31:403-13.  Back to cited text no. 2
Fleming MD, Hunt JL, Purdue GF, Sandstad J. Marjolin's ulcer: A review and reevaluation of a difficult problem. J Burn Care Rehabil 1990;11:460-9.  Back to cited text no. 3
Treves N, Pack GT. The development of cancer in burn scars: An analysis and report of thirty-four cases. Surg Gynecol Obstet 1930;51:749-51.  Back to cited text no. 4
Marjolin JN. ulcer Dictionary of Medicine. Paris: Bechet; 1828. p. 21  Back to cited text no. 5
Steffen C. Marjolin's ulcer. Report of two cases and evidence that Marjolin did not describe cancer arising in scars of burns. Am J Dermatopathol 1984;6:187-93.  Back to cited text no. 6
Dupuytren G (ed): De l'oedeme chronique des tumeurs enkystées des paupières. In Leçons Orales de Clinique Chirurgicale, 2nd ed, vol 3, pp 377-8.  Back to cited text no. 7
Da Costa JC 3rd. Carcinomatous changes in an area of chronic ulceration, or Marjolin's ulcer. Ann Surg 1903;37:496-502.  Back to cited text no. 8
Yu N, Long X, Lujan-Hernandez JR, Hassan KZ, Bai M, Wang Y, et al. Marjolin's ulcer: A preventable malignancy arising from scars. World J Surg Oncol 2013;11:313.  Back to cited text no. 9
Pekarek B, Buck S, Osher L. A comprehensive review on Marjolin's ulcers: Diagnosis and treatment. J Am Col Certif Wound Spec 2011;3:60-4.  Back to cited text no. 10
Kerr-Valentic MA, Samimi K, Rohlen BH, Agarwal JP, Rockwell WB. Marjolin's ulcer: Modern analysis of an ancient problem. Plast Reconstr Surg 2009;123:184-91.  Back to cited text no. 11
Lawrence EA. Carcinoma arising in the scars of thermal burns, with special reference to the influence of the age at burn on the length of the induction period. Surg Gynecol Obstet 1952;95:579-88.  Back to cited text no. 12
Saraiya HA. A very large Marjolin's ulcer on back without lymph node metastasis. Indian J Plast Surg 2013;46:156-8.  Back to cited text no. 13
[PUBMED]  [Full text]  
Daya M, Balakrishan T. Advanced Marjolin's ulcer of the scalp in a 13-year-old boy treated by excision and free tissue transfer: Case report and review of literature. Indian J Plast Surg 2009;42:106-11.  Back to cited text no. 14
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Mohammadi AA, Seyed Jafari SM, Hosseinzadeh M. Early Marjolin's ulcer after minimal superficial burn. Iran J Med Sci 2013;38:69-70.  Back to cited text no. 15
Al-Zacko SM. Malignancy in chronic burn scar: A 20 year experience in Mosul-Iraq. Burns 2013;39:1488-91.  Back to cited text no. 16
Bagri-Manjrekar K, Chaudhary M, Sridharan G, Tekade SR, Gadbail AR, Khot K. In vivo autofluorescence of oral squamous cell carcinoma correlated to cell proliferation rate. J Cancer Res Ther. 2018;14:553-8. doi: 10.4103/0973-1482.172710.  Back to cited text no. 17
Agarwal R, Chaudhary M, Bohra S, Bajaj S. Evaluation of natural killer cell (CD57) as a prognostic marker in oral squamous cell carcinoma: An immunohistochemistry study. J Oral Maxillofac Pathol 2016;20:173-7.  Back to cited text no. 18
[PUBMED]  [Full text]  


  [Figure 1], [Figure 2], [Figure 3]


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