Ann. Medit. Burns Club - voL VII - n. 4 - December 1994


Zermani R.*, Toschi S.*, Ricci R.**

* Divisione di Chirurgia Plastica. e Ricostruttiva e Centro Ustioni, Universiti degli Studi di Parma, Parma, Italy
** Istituto di Anatomia Patologica, Universit~t degli Studi di Parma

SUMMARY. An unusual case is described of basal cell epitheliorna in the pre-sternal area in an elderly man, who had suffered bums in the same area some 65 years previously. The neoformation was excised and a Limberg flap was used to repair substance loss. It is recommended that untreated burn scars should be periodically checked for local signs such as ulceration, bleeding and the presence of pus.


The association between burn scars and skin cancer was first noticed by Celsus in the year 100 BC, but it was only in the last century (1828) that Marjolin provided an accurate first clinical description. Research was later perfected and a number of other cases have been reported in the literature.
The most frequently encountered histological type is squamous cell carcinoma. Basal cell carcinoma is rarer (0.5% of all basal cell carcinomas derive from bum scars) and occurs in particular when it is more superficial, with conservation of the hair follicles between the time of the lesion and the onset of the neoplasia; the onset varies, according to the case-histories reported, between 8 and 63 years (mean, 28.5 years). The case that came to our attention was unusual for two reasons: the site of the lesion (thorax) and the length of latency (65 years).

Clinical case

In 1992 a 70-year-old patient presented with an ulcefated nodular lesion in the pre~sternal area associated with a scar. Anamnesis found that the patient as a child had suffered a boiling water burn in the same site. The clinical aspect of the lesion suggested prickle cell carcinoma or a Marjolin ulcer.
We excised the neoformation maintaining cancerological safety margins and repaired the substance loss using a Limberg flap. The histological examination revealed the presence of a basal cell epithelioma: in the dermis, as a direct continuation of the epithelium lining, it was possible to observe islands of thin bundles, anastomized together, composed of neoplastic cells with an ample oval nucleus, entirely basophilic and with scarce cytoplasm. It was also possible to observe parakeratotic areas and small corneous pearls.
The healing of the substance loss was good and controls at one, three, six and twelve months have not shown any sign of recidivation of the tumour or pathological scarring.

Discussion and conclusion

The precise mechanism of the malignant degeneration of scars is not known. Most theories hypothesize chronic irritation of the scar as the triggering factor for the development of a carcinoma. According to some studies, slow initial recovery of the lesion and scar instability are important factors. Genetic predisposition and immumodepression would appear to be less significant pathogenetic factors.
The most appropriate treatment is to perform a biopsy excision of the lesion with a 2 em margin and, if possible, to effect skin repair with free skin grafts or local flaps.
Burn scars should always be checked periodically, especially scars that have not been subjected to surgical procedures and grafting because they seem most liable to develop malignancies after surgery, in order to discover in good time any local signs such as ulcerations, bleeding and the presence of pus, which are all indications for surgical removal.

RESUME. Les auteurs décrivent un cas peu commun d'épithélioma basocellulaire dans la région antérieure du sternum dans un patient àgé qui avait souffert des brûlures dans la même région 65 ans auparavant. La néoformation a été excisée et la perte de substance réparée avec un lambeau de Limberg. Les auteurs recommandent que les cicatrices de brûlures non traitées soient contrôlées périodiquement pour constater s'il y a des signes locaux comme l'ulcération, le saignement ou la présence de pus.


  1. Abbas J. S., Beecham J. E.: Bum wound carcinoma: case report and review of the literature. Burns, 14: 222, 1988.
  2. Bostwich J., Prendergast W. J., Vasonez L. 0.: Marjolin's ulcer: animmunologically privileged tumor? Plast. Reconstr. Surg., 57: 66, 1976.
  3. Nancarrow J. D.: Cicauicial cancer in the south-west of England: a Regional Plastic Surgery Unit's experience over a 20-year period. Brit. J. Surg., 70: 205, 1983.
  4. Xie-Er-Fan et al.: Burn scar carcinoma: case reports and review of the literature. Ann. Medit. Bums Club, 5: 102, 1992.


The MBC, in the context of the activities laid down in its statute and intended to promote burn prevention campaigns, has produced the following videotapes: - The Prevention of Burns in Children - The Prevention of Electrical Bums in Everyday Life - The Prevention of Electrical Bums at Work - The Prevention of Industrial Disasters - How to Defend ourselves from Fire - How to Defend ourselves from Forest Fire The tapes have been dubbed in English, French, Arabic, Italian, Spanish, Greek and Turkish and come in two versions, U-MATIC and VHS. All the tapes are available entirely free of charge to MBC Members who apply in writing to receive them explaining their reasons and undertaking to use them exclusively to promote a burn prevention campaign in their respective countries. Applications must be fowarded to the MBC Secretariat.


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