Gamatsi I E, McCulloch T A, Bailie F B, Srinivasan J R
Department of Plastic and Reconstructive Surgery and Burns Unit, Nottingham City Hospital, UK.
Br J Plast Surg. 2000 Jun;53(4):342-4. doi: 10.1054/bjps.2000.3322.
Malignant melanomas (MM) arising in burn scars are rare with 16 cases previously reported. Malignant melanomas arising on skin grafts are even more rare with only two cases reported. We present the case of MM arising on a burned area that had been previously grafted with a split thickness skin graft. A 19-year-old patient sustained 20% burns in a road traffic accident. The burned areas were debrided and skin grafted. Six months later, the patient developed MM on the left calf (an area that was burned and grafted). The tumour was excised with wide margins. Six months following the excision of the MM, the patient started to develop multiple dysplastic naevi in the skin grafted burned areas. In the present case, the main question to be answered is whether the MM arose from the donor or the recipient site of the split thickness skin graft. After thorough discussion of the two options and reviewing the literature, the authors believe that the MM and the atypical naevi were transferred to the recipient site with the skin graft. Therefore, it is suggested that in the process of harvesting skin grafts, any pre-existing naevi should be avoided or removed, and if this is not feasible, should be recorded in detail in the operation notes. Also, patients at discharge should be advised that any change in the appearance of the grafts or any new lesions in the engrafted areas should be reported to their physicians.
烧伤瘢痕中发生的恶性黑色素瘤（MM）很罕见，此前仅报道过16例。皮肤移植后发生的恶性黑色素瘤更为罕见，仅报道过2例。我们报告了1例发生在曾接受过中厚皮片移植的烧伤区域的MM病例。一名19岁患者在道路交通事故中遭受了20%的烧伤。对烧伤区域进行了清创并进行了皮肤移植。6个月后，患者在左小腿（烧伤并接受移植的区域）发生了MM。肿瘤被广泛切除。MM切除6个月后，患者在接受皮肤移植的烧伤区域开始出现多个发育异常痣。在本病例中，需要回答的主要问题是MM是起源于中厚皮片的供体部位还是受体部位。在对这两种可能性进行充分讨论并查阅文献后，作者认为MM和非典型痣是随皮肤移植转移到受体部位的。因此，建议在采集皮肤移植时，应避免或切除任何已有的痣，如果无法做到这一点，应在手术记录中详细记录。此外，出院时应告知患者，移植部位外观的任何变化或移植区域出现的任何新病变都应向医生报告。
