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| CASE REPORT |
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| Year : 2020 | Volume
: 15
| Issue : 2 | Page : 330-332 |
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Squamous cell carcinoma (Epithelioma) in postburn scar over foot
Suresh S Chandak1, Sandip Shinde2, Prajawalam Rathod2
1 Department of General Surgery, JNMC, DMIMS, Wardha, Maharashtra, India
2 Department of General Surgery, JNMC, Wardha, Maharashtra, India
| Date of Submission | 02-Jun-2018 |
| Date of Acceptance | 23-Aug-2019 |
| Date of Web Publication | 21-Dec-2020 |
Correspondence Address:
Dr. Sandip Shinde
Department of General Surgery, JNMC, Sawangi, Meghe, Wardha, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jdmimsu.jdmimsu_42_18
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 |
| Introduction | |  |
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 | | |
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.
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].
The patient was discharged after 2 weeks and survived for more than 5 years without any adjuvant chemotherapy or radiotherapy [Figure 3].
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 | | |
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
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
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