A case report: Management dilemma in a large fungating squamous cell carcinoma over a Marjolin's ulcer on the chest wall coexisting with severe post burn contracture of the neck.

INTRODUCTION AND IMPORTANCE

Marjolin's ulcer is a premalignant condition occurring over scars and chronically inflamed tissue. Squamous cell carcinoma is the most common malignancy associated with Marjolin's ulcer. These are rare tumors which spread locally and once infiltrating, may lead to distant spread. In our case recurrent bleeding causing severe anaemia and foul smelling discharge, mandated an early resection, the problem in this case was due to his chest condition and severe post-burn neck contracture and he was unfit for general anesthesia. He was subjected to serial local excisions as well as subsequent serial skin grafts.

CASE PRESENTATION

We present a case of a large fungating squamous cell carcinoma in a patent having burn scar over his chest as well has having post-burn contracture of the neck, posing problems in management due to intubation issues.

DISCUSSION

The progression of disease and metastasis is relatively slow due to scarring and meager lymphatic and vascular supply over these scars. Owing to the complexities and urgency, we managed him unconventionally with serial excision under local anesthesia and skin grafting of the wound.

CONCLUSION

Some alterations in management may be a gift of life in such patients is the message through this case.