Sanjay Suruchi, Choudhary Aman, Kumari Meena, Pandya Bharati, Kumar Vinay
Department of General Surgery, All India Institute of Medical Sciences Bhopal, M.P., India.
Department of Surgical Oncology, All India Institute of Medical Sciences Bhopal, M.P., India.
Int J Surg Case Rep. 2023 Sep;110:108440. doi: 10.1016/j.ijscr.2023.108440. Epub 2023 Jul 28.
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.
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.
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.
Some alterations in management may be a gift of life in such patients is the message through this case.
马乔林溃疡是一种发生于瘢痕及慢性炎症组织上的癌前病变。鳞状细胞癌是与马乔林溃疡相关的最常见恶性肿瘤。这些肿瘤较为罕见，呈局部扩散，一旦发生浸润，可能导致远处转移。在我们的病例中，反复出血导致严重贫血及恶臭分泌物，因此需要早期切除，该病例的问题在于患者的胸部情况以及严重的烧伤后颈部挛缩，且他不适合全身麻醉。他接受了系列局部切除及后续系列皮肤移植。
我们呈现一例患有胸部烧伤瘢痕及烧伤后颈部挛缩的患者，其患有巨大蕈样鳞状细胞癌，因插管问题给治疗带来困难。
由于瘢痕形成以及这些瘢痕处淋巴和血管供应稀少，疾病进展和转移相对缓慢。鉴于情况复杂且紧急，我们在局部麻醉下通过系列切除及伤口皮肤移植对其进行了非常规治疗。
通过该病例传递的信息是，在这类患者中，治疗方式的一些改变可能是给予生命的礼物。
