Clinical diagnosis and treatment of 14 cases of scar cancer ulcer wound on head and face_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHEN Xinchong ¹ ,  HUANG Guangtao ^1,2

1. Department of Burn and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563000, P. R. China;
2. Department of Burn and Plastic Surgery, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People’s Hospital), Shenzhen Guangdong, 518000, P. R. China;

Corresponding?author：

HUANG Guangtao, Email: haitao3140@sina.com

Keywords：

Scar cancer; ulcer wound; flap repair

DOI：

10.7507/1002-1892.202312020

Video：

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Objective To analyze the clinical characteristics of scar cancer ulcer wound of head and face, and to investigate its diagnosis and treatment. Methods The clinical data of 14 patients with head and facial scar cancer ulcer wounds who met the selection criteria and admitted between January 2021 and March 2022 were retrospectively analyzed. There were 8 males and 6 females. The age of onset ranged from 21 to 81 years with an average age of 61.6 years. The incubation period ranged from 1 month to 70 years, with a median of 4 years. Site of the disease included 7 cases of head, 6 cases of maxillofacial region, and 1 case of neck region. Injury factors included trauma in 5 cases, scratch in 5 cases, scalding in 2 cases, burn in 1 case, and needle puncture in 1 case. Pathological results showed squamous cell carcinoma in 9 cases, basal cell carcinoma in 3 cases, sebaceous adenocarcinoma in 1 case, papillary sweat duct cystadenoma combined with tubular apocrine sweat gland adenoma in 1 case. There was 1 case of simple extensive tumor resection, 1 case of extensive tumor resection and skin grafting repair, 7 cases of extensive tumor resection and local flap repair, and 5 cases of extensive tumor resection and free flap repair. Results All the 14 patients were followed up 16-33 months (mean, 27.8 months). Two patients (14.29%) had scar cancer ulcer wound recurrence, of which 1 patient recurred at 2 years after 2 courses of postoperative chemotherapy, and was still alive after oral traditional Chinese medicine treatment. One patient relapsed at 1 year after operation and died after 2 courses of chemotherapy. One patient underwent extensive resection of the left eye and periocular tumor and the transfer and repair of the chimaeric muscle axial flap with the perforating branch of the descending branch of the left lateral circumflex femoral artery, but the incision healing was poor after operation, and healed well after anti-infection and debridement suture. The wounds of other patients with scar cancer ulcer did not recur, and the wounds healed well. Conclusion Scar cancer ulcer wound of the head and face is common in the middle-aged and elderly male, and the main pathological type is squamous cell carcinoma. Local extensive resection, skin grafting, or flap transfer repair are the main treatment methods. Early active treatment of wounds after various injuries to avoid scar repeated rupture and infection is the foundamental prevention of scar cancer.

Citation： CHEN Xinchong, HUANG Guangtao. Clinical diagnosis and treatment of 14 cases of scar cancer ulcer wound on head and face. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(3): 342-347. doi: 10.7507/1002-1892.202312020 Copy

1.	Alonso Batanero E, Díaz Rivero Má, Vargas Pierola HJ, et al. Marjolin’s ulcer due to congenital myelomeningocele. Cir Esp (Engl Ed), 2023, 101(4): 288.
2.	Choa R, Rayatt S, Mahtani K. Marjolin’s ulcer. BMJ, 2015, 351: h3997.
3.	Iqbal FM, Sinha Y, Jaffe W. Marjolin’s ulcer: a rare entity with a call for early diagnosis. BMJ Case Rep, 2015, 2015: bcr2014208176.
4.	Sadegh Fazeli M, Lebaschi AH, Hajirostam M, et al. Marjolin’s ulcer: clinical and pathologic features of 83 cases and review of literature. Med J Islam Repub Iran, 2013, 7(4): 215-224.
5.	Tobin C, Sanger JR. Marjolin’s ulcers: A case series and literature review. Wounds, 2014, 26(8): 248-254.
6.	Pekarek B, Buck S, Osher L. A comprehensive review on marjolin’s ulcers: Diagnosis and treatment. J Am Col Certif Wound Spec, 2011, 3(3): 60-64.
7.	Copcu E, Aktas A, Si?man N, et al. Thirty-one cases of Marjolin’s ulcer. Clin Exp Dermatol, 2003, 28(2): 138-141.
8.	Khan K, Giannone AL, Mehrabi E, et al. Marjolin’s ulcer complicating a pressure sore: the clock is ticking. Am J Case Rep, 2016, 17: 111-114.
9.	Smith J, Mello LF, Nogueira Neto NC, et al. Malignancy in chronic ulcers and scars of the leg (Marjolin’s ulcer): a study of 21 patients. Skeletal Radiol, 2001, 30(6): 331-337.
10.	Fairbairn NG, Hamilton SA. Management of Marjolin’s ulcer in a chronic pressure sore secondary to paraplegia: a radical surgical solution. Int Wound J, 2011, 8(5): 533-536.
11.	Copcu E. Marjolin’s ulcer: a preventable complication of burns? Plast Reconstr Surg, 2009, 124(1): 156e-164e.
12.	Metwally IH, Roshdy A, Saleh SS, et al. Epidemiology and predictors of recurrence of Marjolin’s ulcer: experience from Mansoura Universityxs. Ann R Coll Surg Engl, 2017, 99(3): 245-249.
13.	Kowal-Vern A, Criswell BK. Burn scar neoplasms: a literature review and statistical analysis. Burns, 2005, 31(4): 403-413.
14.	Huang CY, Feng CH, Hsiao YC, et al. Burn scar carcinoma. J Dermatolog Treat, 2010, 21(6): 350-356.
15.	Soto-Dávalos BA, Cortés-Flores AO, Bandera-Delgado A, et al. Malignant neoplasm in burn scar: Marjolin’s ulcer. Report of two cases and review of the literature. Cir Cir, 2008, 76(4): 329-331.
16.	Alterio D, Marvaso G, Ferrari A, et al. Modern radiotherapy for head and neck cancer. Semin Oncol, 2019, 46(3): 233-245.
17.	Kennel T, Garrel R, Costes V, et al. Head and neck carcinoma of unknown primary. Eur Ann Otorhinolaryngol Head Neck Dis, 2019, 136(3): 185-192.
18.	Zhong NN, Wang HQ, Huang XY, et al. Enhancing head and neck tumor management with artificial intelligence: Integration and perspectives. Semin Cancer Biol, 2023, 95: 52-74.
19.	周政, 吳牡麗, 李維, 等. 頭頸腫瘤術后壓力感受器衰竭綜合征. 臨床耳鼻咽喉頭頸外科雜志, 2021, 35(11): 1052-1056.
20.	Brennan M, Wong S, Faringer PD, et al. Head and neck tumor resection and free flap reconstruction in low-volume center. Ear Nose Throat J, 2021, 100(9): 647-650.
21.	王耿煥, 顏羽, 沈和平, 等. 皮肌瓣一次性分離技術在額顳部顱骨修補術中的應用. 中華神經外科雜志, 2023, 39(3): 274-278.
22.	何晨曦, 鄭德義. 老年皮膚瘢痕癌臨床特征及其預后影響因素. 中國老年學雜志, 2021, 41(2): 268-271.
23.	劉梅, 趙琰, 何春滌, 等. 皮膚瘢痕癌45例回顧性分析. 中國美容醫學, 2010, 19(4): 540-542.
24.	Erickson LA. Sebaceous carcinoma. Mayo Clin Proc, 2021, 96(8): 2285-2287.
25.	Owen JL, Kibbi N, Worley B, et al. Sebaceous carcinoma: evidence-based clinical practice guidelines. Lancet Oncol, 2019, 20(12): e699-e714.
26.	Ferreira I, Wiedemeyer K, Demetter P, et al. Update on the pathology, genetics and somatic landscape of sebaceous tumours. Histopathology, 2020, 76(5): 640-649.
27.	Zwierz A, Masna K, Burduk P. Syringocystadenoma papilliferum revealed 12 years after surgical treatment of chronic ear with cholesteatoma: Presentation of an unusual case and literature review. J Int Adv Otol, 2022, 18(6): 544-547.
28.	Eiger-Moscovich M, Zhang PJL, Lally SE, et al. Tubular apocrine adenoma of the eyelid—A case report and literature review. Saudi J Ophthalmol, 2019, 33(3): 304-307.
29.	Choi J, Seo JH, Choi JY, et al. Apocrine tubular adenoma on the palm: A case report. Medicine (Baltimore), 2021, 100(49): e28002.
30.	馬偉元, 劉文, 李學忠, 等. Mohs顯微描記手術在鼻面部基底細胞癌中的應用. 中華耳鼻咽喉頭頸外科雜志, 2018, 53(6): 440-443.
31.	Khan K, Schafer C, Wood J. Marjolin ulcer: A comprehensive review. Adv Skin Wound Care, 2020, 33(12): 629-634.

1. Alonso Batanero E, Díaz Rivero Má, Vargas Pierola HJ, et al. Marjolin’s ulcer due to congenital myelomeningocele. Cir Esp (Engl Ed), 2023, 101(4): 288.
2. Choa R, Rayatt S, Mahtani K. Marjolin’s ulcer. BMJ, 2015, 351: h3997.
3. Iqbal FM, Sinha Y, Jaffe W. Marjolin’s ulcer: a rare entity with a call for early diagnosis. BMJ Case Rep, 2015, 2015: bcr2014208176.
4. Sadegh Fazeli M, Lebaschi AH, Hajirostam M, et al. Marjolin’s ulcer: clinical and pathologic features of 83 cases and review of literature. Med J Islam Repub Iran, 2013, 7(4): 215-224.
5. Tobin C, Sanger JR. Marjolin’s ulcers: A case series and literature review. Wounds, 2014, 26(8): 248-254.
6. Pekarek B, Buck S, Osher L. A comprehensive review on marjolin’s ulcers: Diagnosis and treatment. J Am Col Certif Wound Spec, 2011, 3(3): 60-64.
7. Copcu E, Aktas A, Si?man N, et al. Thirty-one cases of Marjolin’s ulcer. Clin Exp Dermatol, 2003, 28(2): 138-141.
8. Khan K, Giannone AL, Mehrabi E, et al. Marjolin’s ulcer complicating a pressure sore: the clock is ticking. Am J Case Rep, 2016, 17: 111-114.
9. Smith J, Mello LF, Nogueira Neto NC, et al. Malignancy in chronic ulcers and scars of the leg (Marjolin’s ulcer): a study of 21 patients. Skeletal Radiol, 2001, 30(6): 331-337.
10. Fairbairn NG, Hamilton SA. Management of Marjolin’s ulcer in a chronic pressure sore secondary to paraplegia: a radical surgical solution. Int Wound J, 2011, 8(5): 533-536.
11. Copcu E. Marjolin’s ulcer: a preventable complication of burns? Plast Reconstr Surg, 2009, 124(1): 156e-164e.
12. Metwally IH, Roshdy A, Saleh SS, et al. Epidemiology and predictors of recurrence of Marjolin’s ulcer: experience from Mansoura Universityxs. Ann R Coll Surg Engl, 2017, 99(3): 245-249.
13. Kowal-Vern A, Criswell BK. Burn scar neoplasms: a literature review and statistical analysis. Burns, 2005, 31(4): 403-413.
14. Huang CY, Feng CH, Hsiao YC, et al. Burn scar carcinoma. J Dermatolog Treat, 2010, 21(6): 350-356.
15. Soto-Dávalos BA, Cortés-Flores AO, Bandera-Delgado A, et al. Malignant neoplasm in burn scar: Marjolin’s ulcer. Report of two cases and review of the literature. Cir Cir, 2008, 76(4): 329-331.
16. Alterio D, Marvaso G, Ferrari A, et al. Modern radiotherapy for head and neck cancer. Semin Oncol, 2019, 46(3): 233-245.
17. Kennel T, Garrel R, Costes V, et al. Head and neck carcinoma of unknown primary. Eur Ann Otorhinolaryngol Head Neck Dis, 2019, 136(3): 185-192.
18. Zhong NN, Wang HQ, Huang XY, et al. Enhancing head and neck tumor management with artificial intelligence: Integration and perspectives. Semin Cancer Biol, 2023, 95: 52-74.
19. 周政, 吳牡麗, 李維, 等. 頭頸腫瘤術后壓力感受器衰竭綜合征. 臨床耳鼻咽喉頭頸外科雜志, 2021, 35(11): 1052-1056.
20. Brennan M, Wong S, Faringer PD, et al. Head and neck tumor resection and free flap reconstruction in low-volume center. Ear Nose Throat J, 2021, 100(9): 647-650.
21. 王耿煥, 顏羽, 沈和平, 等. 皮肌瓣一次性分離技術在額顳部顱骨修補術中的應用. 中華神經外科雜志, 2023, 39(3): 274-278.
22. 何晨曦, 鄭德義. 老年皮膚瘢痕癌臨床特征及其預后影響因素. 中國老年學雜志, 2021, 41(2): 268-271.
23. 劉梅, 趙琰, 何春滌, 等. 皮膚瘢痕癌45例回顧性分析. 中國美容醫學, 2010, 19(4): 540-542.
24. Erickson LA. Sebaceous carcinoma. Mayo Clin Proc, 2021, 96(8): 2285-2287.
25. Owen JL, Kibbi N, Worley B, et al. Sebaceous carcinoma: evidence-based clinical practice guidelines. Lancet Oncol, 2019, 20(12): e699-e714.
26. Ferreira I, Wiedemeyer K, Demetter P, et al. Update on the pathology, genetics and somatic landscape of sebaceous tumours. Histopathology, 2020, 76(5): 640-649.
27. Zwierz A, Masna K, Burduk P. Syringocystadenoma papilliferum revealed 12 years after surgical treatment of chronic ear with cholesteatoma: Presentation of an unusual case and literature review. J Int Adv Otol, 2022, 18(6): 544-547.
28. Eiger-Moscovich M, Zhang PJL, Lally SE, et al. Tubular apocrine adenoma of the eyelid—A case report and literature review. Saudi J Ophthalmol, 2019, 33(3): 304-307.
29. Choi J, Seo JH, Choi JY, et al. Apocrine tubular adenoma on the palm: A case report. Medicine (Baltimore), 2021, 100(49): e28002.
30. 馬偉元, 劉文, 李學忠, 等. Mohs顯微描記手術在鼻面部基底細胞癌中的應用. 中華耳鼻咽喉頭頸外科雜志, 2018, 53(6): 440-443.
31. Khan K, Schafer C, Wood J. Marjolin ulcer: A comprehensive review. Adv Skin Wound Care, 2020, 33(12): 629-634.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical diagnosis and treatment of 14 cases of scar cancer ulcer wound on head and face

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