Recurrent Dystrophic Calcification and Squamous Cell Carcinoma in a Cultured Keratinocyte Scar 35 Years After a 60%...

Dystrophic calcification of burn scars is a rare but disabling late complication that can result in chronic ulceration and increase the risk of squamous cell carcinoma. A male patient sustained burns covering 60% of his total body surface in 1989 and received a combination of split-thickness autografts, paternal homografts, and cultured keratinocyte sheet grafts. The first ulcer appeared in 2004 and recurrent lower limbs ulcerations continued intermittently over the following 2 decades. Imaging and histopathology revealed subcutaneous calcium deposits and 3 distinct well-differentiated squamous cell carcinomas. The carcinoma developed in areas of chronic ulceration, consistent with the pathogenesis of Marjolin ulcer. Over the subsequent years, he underwent 25 surgical procedures for excision of calcific nodules and malignancies, followed by reconstruction of resultant defects. Throughout follow-up, serum calcium, phosphate, and renal function remained within normal limits. Calcinosis cutis may manifest decades after deep burns, even in areas resurfaced with cultured epithelial grafts. Complete surgical excision of calcific deposits resolves ulceration, whereas delayed recognition can hinder healing and permit malignant transformation. Persistent chronic ulceration may predispose to squamous cell carcinoma, highlighting the importance of early recognition and biopsy. Lifelong surveillance of extensive burn scars is therefore recommended.