Mellemkjaer Lene, Hölmich Lisbet R, Gridley Gloria, Rabkin Charles, Olsen Jørgen H
Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark.
Epidemiology. 2006 Nov;17(6):668-73. doi: 10.1097/01.ede.0000239651.06579.a4.
Malignant degeneration of chronic ulcers such as nonhealed burn wounds has been described in the literature, but this phenomenon has never been quantified in an epidemiologic study. We investigated the risks for skin and other cancers among patients with a prior burn.
We identified 16,903 patients from the Danish Hospital Discharge Register who had been admitted to a hospital with a thermal or chemical burn during 1978 to 1993. The cohort was followed for cancer in the Danish Cancer Registry through 2002, and the cancer incidence in the cohort was compared with that in the general population of Denmark.
Patients with burn had 139 skin cancers, with 189 expected, yielding a standardized incidence ratio of 0.7 (95% confidence interval = 0.6-0.9). This reduced risk was due mainly to deficits of basal cell carcinoma and malignant melanoma, whereas the number of squamous cell carcinomas observed was close to expected. We saw no consistent increases in risk for skin cancer in the subgroups of patients with the most severe injuries or with the longest periods of follow up.
The tendency to malignant degeneration of burn scars, described in previous reports of case series, did not result in an excess of squamous cell carcinoma of the skin or of any other type of skin cancer during up to 25 years' follow up of a large unselected cohort of patients hospitalized for burn injuries.
慢性溃疡（如未愈合的烧伤创面）的恶性变在文献中已有描述，但这一现象从未在流行病学研究中进行过量化。我们调查了既往有烧伤史的患者患皮肤癌和其他癌症的风险。
我们从丹麦医院出院登记处识别出16903例在1978年至1993年期间因热烧伤或化学烧伤入院的患者。该队列在丹麦癌症登记处随访至2002年，并将该队列中的癌症发病率与丹麦普通人群的发病率进行比较。
烧伤患者发生139例皮肤癌，预期为189例，标准化发病比为0.7（95%置信区间=0.6-0.9）。这种风险降低主要是由于基底细胞癌和恶性黑色素瘤的病例数不足，而观察到的鳞状细胞癌数量接近预期。在伤势最严重或随访时间最长的患者亚组中，我们未发现皮肤癌风险有持续增加。
在对一大组因烧伤住院的未选择患者进行长达25年的随访期间，既往病例系列报告中描述的烧伤瘢痕恶性变倾向并未导致皮肤鳞状细胞癌或任何其他类型皮肤癌的超额发生。
