Pieptu D, Luchian S, Copăceanu M, Popa M, Hriscu M, Stătescu C
Clinica de Chirurgie Plastică şi Reconstructivă, Facultatea de Medicină, Universitatea de Medicina si Farmacie Gr.T. Popa, Iaşi.
Rev Med Chir Soc Med Nat Iasi. 2000 Oct-Dec;104(4):95-9.
We discuss 9 consecutive carcinomas developed on postburn scars. Our interest was focused on surgery, recurrence, metastasis and long-term survival. The delay between burn trauma and the first clinical manifestation was 25-63 years. The most common localisation was in the limbs (10). Two cases presented with visceral metastasis. We performed either wide excision and grafting (5) or amputation (5). From the anatomo-pathological stand point we encountered 8 SCC and 1 BCC. In 6 cases we had no local recidive or metastasis. One presented a local recidive. There were two deaths--lung metastasis and "spontaneous" rupture of invaded axillary artery. The Marjolin's ulcer has a low incidence because of the patient's poor education. The prophylactic attitude is optimal. We favour early excision--grafting of the deep burns, long-term follow-up, excision and grafting of unstable areas (joint area, depigmented regions, chronic ulcers). The optimal surgical technique is excision followed by skin grafting since it allows early detection of the recurrence.
我们讨论了9例发生于烧伤瘢痕上的连续性癌。我们关注的重点在于手术、复发、转移及长期生存情况。烧伤创伤与首次临床表现之间的间隔时间为25至63年。最常见的发病部位在四肢（10例）。有2例出现内脏转移。我们进行了广泛切除并植皮（5例）或截肢（5例）。从解剖病理学角度来看，我们发现8例鳞状细胞癌和1例基底细胞癌。6例未出现局部复发或转移。1例出现局部复发。有2例死亡——1例因肺转移，1例因受累腋动脉“自发性”破裂。由于患者教育程度低，Marjolin溃疡的发病率较低。预防性措施是最佳的。我们主张早期切除——深度烧伤的植皮、长期随访、不稳定区域（关节部位、色素脱失区域、慢性溃疡）的切除及植皮。最佳的手术技术是切除后植皮，因为这样能早期发现复发。
