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Melanoma Marjolin's ulcer in the hand: A case report
Rafaela Pais Serras1, David Carvalho Rasteiro1, Maria Manuel Mendes1
1Department of Plastic and Reconstructive Surgery, Hospital de São José, 1150-199, Lisbon, Portugal.
Introduction:
Burn scars have the potential to malignant transformation, creating an identity named Marjolin's ulcer. This term refers to any scar in a traumatized skin that degenerates into a skin cancer. The majority of them are derived from burns that were not grafted, appearing several years later. The most frequent type is squamous cell carcinoma with few cases of melanoma described in the literature. This last one accounts for a poor prognosis.
Case Presentation:
Female, 74 years old, presents to our department with a malignant melanoma arising from a thermal burn scar in the right thenar eminence 14 years after the initial injury. The lesion was excised and the defect covered by a full thickness skin graft. At 6 months post-operatively there are no signs of locoregional recurrence or systemic dissemination.
Discussion:
Malignant melanoma arising from a burn scar is extremely rare and the pathogenesis is unknown. Many theories try to explain this low incidence and the factors that contribute to degenerative changes of melanocytes in the affected skin.
Conclusion:
Health professionals must consider this pathology when evaluating a burn scar or a chronic wound, performing a biopsy when suspicion is high. An early diagnosis, a prompt surgical intervention and a greater vigilance are the keys to success and survival.