Kasse A A, Betel E, Dem A, Diop M, Fall M C, Diop P S, Dembele B, Drabo B, Timbely G, Neloum J, Toure P
Institut Ouest Africain de Lutte contre le Cancer, Université Cheikh Anta DIOP, Dakar-Fann Sénégal.
Dakar Med. 1999;44(2):206-10.
Burns are very frequent. Skin cancer on burns scars are one of the known complications. The mechanisms and the risk factors of this disease are not very well known. To review the risk factors and the mechanisms of transformation of burn scars into cancer, we analyzed 67 retrospective cases of Marjolin's ulcer to describe the epidemiological features of the disease in our practice and identify the factors of relapse. Our patients are young (means age 41), mainly male (54%), with disease localized on arms and legs (88%). The initial burn was from flames (54%), charcoal or hot cooking oil (19.5%) and never from ionizing radiation. It was never a superficial burn and covered from 4 to 37% of the body surface (mean 14%). The initial treatment was medical in only 9% of cases and ended with 85% of complete healing. After 4 to 67 years of evolution, 95% of re-ulceration occurred. Abnormal lymph node and distant metastasis were diagnosed in respectively 68 and 7% of the cases. Amputation and groin dissection were respectively done in 63 and 50%. One third of patients were lost during the follow up. 25% of the cases are still alive and free of disease. We found 30% of local recurrence and 17.5% of regional recurrence. By univariate analysis we found that the factors significantly associated to loco-regional relapse are: male status (p = 0.0327), burns by cooking oil (p = 0.0118), lack of treatment during initial burn (p = 0.0001), sclerous scar (p = 0.0281), supra regional lymph nodes (p = 0.028) lack of treatment during re ulceration (p = 0.0308). Squamous cell carcinomas on burn scars are rare diseases and of bad prognosis. Mainly associated to domestic accidents they frequently occur on limbs and arms on an articulation. Metastasis is not frequent. Conservative treatment is associated with 30% of recurrence. In our practice, the relapse risk factors are male status, burns by cooking oil, lack of treatment during the initial burn, sclerous scar, supra regional lymph nodes, lack of treatment during re ulceration.
烧伤非常常见。烧伤瘢痕上的皮肤癌是已知的并发症之一。这种疾病的发病机制和危险因素尚不完全清楚。为了回顾烧伤瘢痕转变为癌症的危险因素和机制，我们分析了67例Marjolin溃疡的回顾性病例，以描述该病在我们临床实践中的流行病学特征，并确定复发因素。我们的患者较为年轻（平均年龄41岁），主要为男性（54%），病变主要位于手臂和腿部（88%）。最初的烧伤由火焰引起（54%），由木炭或热油引起（19.5%），从未由电离辐射引起。烧伤均非浅表性，烧伤面积占体表的4%至37%（平均14%）。仅9%的病例最初采用药物治疗，最终85%完全愈合。经过4至67年的病程，95%发生了再溃疡。分别有68%和7%的病例诊断为异常淋巴结和远处转移。分别有63%和50%的病例进行了截肢和腹股沟淋巴结清扫。三分之一的患者在随访期间失访。25%的病例仍然存活且无疾病。我们发现局部复发率为30%，区域复发率为17.5%。通过单因素分析，我们发现与局部区域复发显著相关的因素有：男性（p = 0.0327）、热油烧伤（p = 0.0118）、初次烧伤时未治疗（p = 0.0001）、瘢痕硬结（p = 0.0281）、区域以上淋巴结（p = 0.028）、再溃疡时未治疗（p = 0.0308）。烧伤瘢痕上的鳞状细胞癌是罕见疾病，预后不良。主要与家庭事故相关，常发生于四肢关节处。转移并不常见。保守治疗的复发率为30%。在我们的临床实践中，复发的危险因素为男性、热油烧伤、初次烧伤时未治疗、瘢痕硬结、区域以上淋巴结、再溃疡时未治疗。
