Burn scars turn into skin cancer

Mr. Zhang, 31 years old, was admitted to the hospital because of a mass on the right abdominal wall that he had found for more than two months.

Medical history

Current medical history: The patient accidentally found a coin-sized mass on the original burn scar on the right abdominal wall more than 2 months ago. The surface was rough, the texture was soft, and it was itchy. He rubbed it with "Piyanping Ointment" by himself, but the symptoms did not ease. Since January, the mass has rapidly increased in size. 2 days ago, the surface of the mass was bleeding and accompanied by a foul odor. Today, he was diagnosed with "left abdominal wall skin cancer" and was admitted to the hospital.

Past medical history: left anterior abdominal wall burn 15 years ago, scar formed after treatment, no skin grafting was performed.

Physical examination

The vital signs were stable, and no obvious abnormalities were found in the head, face, neck, and heart and lung examinations. A mass of about 5*7*6CM in size was seen on the right abdominal wall. It was cauliflower-shaped, pink in color, and partially eroded. Purulent secretions and blood were seen, with a foul odor, a brittle texture, and easy bleeding.

Testing

Blood routine: WBC26.1*109/LRBC3.10*1012/LHGB88G/LGRA91.3%. Routine examinations such as stool and urine routine, electrocardiogram, and X-ray showed no abnormalities.

Diagnosis and treatment

Combined with the clinical and pathological examination results, it was confirmed to be cutaneous squamous cell carcinoma. Squamous cell carcinoma is common in the elderly with an average age of 60 years old, and the most common sites are the face, ears, lower lips, back of hands, etc. In the early stage, it often appears as a small, hard, red nodule with unclear boundaries, which is easy to evolve into a verrucous or papilloma-like shape. The surface may be scaly and the center is prone to ulceration. The surface of the ulcer is granular, prone to necrosis/bleeding, and accompanied by a foul odor. The tumor can expand progressively and further invade subcutaneous tissues such as muscles and bones. Those secondary to radiation dermatitis, scars, ulcers, and sinus tracts are much more metastatic than those secondary to sunlight damage, and are prone to metastasis.

Surgical excision + flap transfer is recommended. The best condition is MOHS surgical excision.

Mr. Zhang underwent surgical resection and skin flap transplantation, and the tumor was completely removed. He is in general good condition.

Tips:

WBC: White blood cell count

RBC: Red blood cell count

HGB: Hemoglobin

GRA: Neutrophil percentage

MOHS: Mohs micrographic surgery