Mousa Ahmed K, Elshenawy Anwar A, Maklad Salah M, Bebars Shaimaa M M, Burezq Hisham A, Sayed Sherif E
Plastic & Reconstructive Surgery - Medical School of Aswan University, Aswan, Egypt.
Surgical Oncology, Aswan University, Aswan, Egypt.
Int Wound J. 2022 May;19(4):895-909. doi: 10.1111/iwj.13690. Epub 2021 Sep 18.
The study spotlights a severe uncommon post-burn complication, Marjolin's ulcer, in upper Egypt plastic and wound care centres. This problem is mainly related to inadequate medical care and awareness. No community or race is immune. The underlying malignant transformation mechanism remains unclear. The study aims, according to our experience, to review the prognostic factors through the management protocol of Marjolin's ulcers. This prospective study was conducted in the Aswan University Plastic & Burn surgery department in South Egypt between 2013 and 2020 and investigated 226 patients with chronic post-burn ulceration. Nineteen cases were proved to have Marjolin's ulcer, and the other cases that had been excluded from being malignant went for reconstruction with split-thickness skin graft with/without flap after adequate ulcer debridement. The surgical, oncologic, radiologic indications, and prognostic factors were reviewed according to our management outcome-the assessment with follow-up period extended over 5 years. Histopathology of ulcers ranged among mild, moderate, and poorly differentiated squamous cell carcinoma. One scalp ulcer case showed basosquamous pathology. Most cases presented at age above 50, but no age was immune. The mean latent period was 29 years on average. The lesions' sites varied in their anatomic location where they involved the upper extremity, the scalp, and the lower extremity that had a predilection. Although surgical excision is the primary management line for tumour ablation, other factors may change the management course. During the follow-up period, neoplasm recurrence in the form of lymph node enlargement and/or locoregional metastasis was detected in eight cases. Within 1 year after the intervention, six recurrent cases died, and two were saved. In addition to the case study, this paper reviewed the literature and provided our team a good experience in light of the NCCN protocol for non-melanotic cutaneous carcinoma, although we suffered limited medical resources. It is concluded that early accurate diagnosis, low-grade malignancy, and well-planned individualised surgery with adjuvant radiotherapy were the best prognostic factors. The close follow-up for an early sign of disease recurrence is paramount.
该研究聚焦于埃及上埃及地区整形与伤口护理中心一种严重且罕见的烧伤后并发症——马乔林溃疡。这一问题主要与医疗护理不足和意识缺乏有关。没有哪个社区或种族能够幸免。其潜在的恶性转化机制仍不清楚。根据我们的经验，该研究旨在通过马乔林溃疡的管理方案来回顾预后因素。这项前瞻性研究于2013年至2020年在埃及南部阿斯旺大学整形与烧伤外科进行，研究了226例慢性烧伤后溃疡患者。其中19例被证实患有马乔林溃疡，其他排除恶性病变的病例在充分清创溃疡后，采用分层皮片移植加/不加皮瓣进行重建。根据我们的治疗结果——随访期延长至5年以上的评估，对手术、肿瘤学、放射学指标及预后因素进行了回顾。溃疡的组织病理学表现为轻度、中度和低分化鳞状细胞癌。1例头皮溃疡病例表现为基底鳞状病理。大多数病例发病年龄在50岁以上，但各年龄段均有发病。平均潜伏期平均为29年。病变部位在解剖位置上各不相同，好发于上肢、头皮和下肢。虽然手术切除是肿瘤切除的主要治疗方法，但其他因素可能会改变治疗进程。在随访期间，8例患者出现了以淋巴结肿大和/或局部区域转移形式的肿瘤复发。干预后1年内，6例复发患者死亡，2例存活。除了病例研究外，本文还回顾了文献，并根据美国国立综合癌症网络（NCCN）非黑色素皮肤癌治疗方案，为我们的团队提供了良好的经验，尽管我们的医疗资源有限。研究得出结论，早期准确诊断、低级别恶性肿瘤以及精心规划的个体化手术联合辅助放疗是最佳的预后因素。密切随访以发现疾病复发的早期迹象至关重要。
