Ames F C, Hickey R C
Int Adv Surg Oncol. 1980;3:179-99.
Nonmelanomatous skin cancer usually occurs in fair-skinned persons on sites chronically exposed to sunlight. In a series of 35,000 patients with skin cancer seen at M. D. Anderson Hospital and Tumor Institute, 1,208 patients (13%) had squamous cell skin cancer of the extremities. Forty-one of these patients had a clear history of a preexisting thermal burn or irradiation dermatitis (Marjolin's ulcer). The average lesion was over 2 cm in diameter, and the average Marjolin's ulcer was over 5 cm. The treatment of choice in this series of relatively large lesions was surgical excision with or without skin grafting and with histologic evaluation of the surgical margins. The local recurrence rate was less than 10%. Regional metastasis developed in 1.4% of the patients and in 44% of those with Marjolin's ulcer. Even with prompt nodal dissection, the five-year survival rate for patients with nodal metastasis was only 35%. The presence of extracapsular spread of nodal disease is of grave significance, and adjunctive radiation therapy should be considered. Careful follow-up of all patients with squamous cell skin cancer is important.
非黑色素瘤性皮肤癌通常发生在皮肤白皙、长期暴露于阳光的部位。在安德森肿瘤研究所就诊的35000例皮肤癌患者中，1208例（13%）患有四肢鳞状细胞皮肤癌。其中41例患者有明确的既往热烧伤或放射性皮炎病史（Marjolin溃疡）。平均病变直径超过2厘米，平均Marjolin溃疡超过5厘米。对于这一系列相对较大的病变，首选治疗方法是手术切除，可伴或不伴皮肤移植，并对手术切缘进行组织学评估。局部复发率低于10%。1.4%的患者发生区域转移，在患有Marjolin溃疡的患者中这一比例为44%。即使及时进行淋巴结清扫，有淋巴结转移的患者五年生存率也仅为35%。淋巴结疾病存在包膜外扩散具有严重意义，应考虑辅助放疗。对所有鳞状细胞皮肤癌患者进行仔细随访很重要。
