Post-burn scar malignancy: 5-year management review and experience

Area of Science:

• Oncology
• Plastic Surgery
• Dermatology

Background:

• Marjolin's ulcer is a severe, uncommon post-burn complication linked to inadequate medical care and awareness.
• Malignant transformation in chronic burn wounds remains a significant clinical challenge, particularly in resource-limited settings.
• Understanding prognostic factors is crucial for effective management of these rare but aggressive neoplasms.

Purpose of the Study:

• To review prognostic factors in the management protocol of Marjolin's ulcers based on clinical experience.
• To analyze outcomes of surgical and adjuvant treatments for Marjolin's ulcers.
• To correlate histopathological findings with patient outcomes and recurrence rates.

Main Methods:

• Prospective study of 226 patients with chronic post-burn ulceration from 2013-2020 in South Egypt.
• In-depth review of 19 confirmed Marjolin's ulcer cases, including surgical, oncologic, and radiologic data.
• Five-year follow-up to assess outcomes, recurrence, and survival, guided by NCCN protocols for non-melanotic cutaneous carcinoma.

Main Results:

• Histopathology revealed squamous cell carcinoma (mild, moderate, poorly differentiated) and one basosquamous case.
• Most patients were over 50, with a mean latent period of 29 years; common sites included extremities and scalp.
• Eight cases (42%) experienced recurrence (lymph node enlargement/metastasis); six died within one year post-intervention.

Conclusions:

• Early accurate diagnosis, low-grade malignancy, and individualized surgery with adjuvant radiotherapy are key prognostic factors.
• Close follow-up is paramount for early detection of disease recurrence.
• Effective management requires a multidisciplinary approach, even with limited medical resources.