obsolete old burn scar-related melanoma of skin

Obsolete Classification of Old Burn Scar-Related Melanoma

Old burn scar-related melanoma, also known as neoplasm of uncertain malignant potential (NUP), is a rare and aggressive form of skin cancer that develops in the scars of old burns. This type of melanoma is characterized by its unique presentation and behavior.

Key Features:

• Symptoms: Hyperpigmentation and the formation of lentigines around melanoma scars are common symptoms of LM/LMM, which primarily develop in areas exposed to the sun [1].
• Treatment Options: Treatment options may include medications, surgical procedures, lifestyle changes, and physical therapy. In some cases, a combination of these approaches may be necessary [2].
• Definition: A neoplasm defined by its unique characteristic as they apply to clinical presentation and course, morphologic patterns, frequency, and/or age distribution [3].

Incidence and Risk Factors:

• Rare Event: The development of malignant melanoma in an old burn scar is an extremely rare event, with only six reports found in the literature [14].
• Risk of Skin Cancer: While there is no increased risk of skin cancer, including squamous cell carcinoma and malignant melanoma, in the burn cohort [13], individual cases can still occur.

Clinical Presentation:

• Lesion Characteristics: Lesions present as pink-to-ivory-white, shiny, smooth, scar-like, indurated plaques or depressions with ill-defined borders. Frequently, there is associated hyperpigmentation [8].
• Growth Pattern: Non-malignant nevi are symmetrical with sharp round or oval outlines and may grow to 6 mm, remain unchanged for years, and even disappear in old age [7].

References:

[1] APDA Boleti (2024) - Hyperpigmentation and the formation of lentigines around melanoma scars are common symptoms of LM/LMM.

[2] Some common treatment options may include medications, surgical procedures, lifestyle changes, and physical therapy. In some cases, a combination of these...

[3] A neoplasm defined by its unique characteristic as they apply to clinical presentation and course, morphologic patterns, frequency, and/or age distribution.

[8] AG Marzuka (2015) - Lesions present as pink-to-ivory-white, shiny, smooth, scar-like, indurated plaques or depressions with ill-defined borders. Frequently, there is associated hyperpigmentation.

[14] The development of malignant melanoma in an old burn scar is an extremely rare event and only six reports could be found in the literature.

Warning Signs and Symptoms of Burn Scar-Related Melanoma

Burn scar-related melanoma, also known as burn scar carcinoma or pseudocarcinomatous hyperplasia, is a rare but aggressive form of skin cancer that can develop in areas where previous burns have occurred. Here are some warning signs and symptoms to look out for:

• Changes in the appearance of the burn scar: The scar may become thicker, more raised, or develop new growths within it.
• Pain or itching: You may experience pain or itching sensations in the affected area, which can be a sign that something is amiss.
• Redness and inflammation: The skin around the burn scar may become red, inflamed, or swollen, indicating an underlying issue.
• Bleeding or oozing: In some cases, the burn scar may start to bleed or ooze fluid, which can be a sign of advanced disease.

Other Risk Factors

In addition to changes in the appearance of the burn scar, there are other risk factors that may increase your likelihood of developing burn scar-related melanoma. These include:

• Fair skin: If you have fair skin that sunburns easily, you may be more susceptible to this type of cancer.
• Lightly pigmented irises: People with lightly pigmented irises (blue or green eye color) may also be at higher risk.
• Freckles in sun-exposed areas: The presence of freckles in sun-exposed skin can indicate a higher risk of developing burn scar-related melanoma.

Early Detection is Key

It's essential to catch this type of cancer early, as it can be more aggressive and difficult to treat if left unchecked. If you notice any unusual changes or symptoms in your burn scars, consult with a dermatologist or healthcare professional right away.

References:

• [4] Melanomas are characterized by dark pigment with asymmetry, border irregularity, color variation, a diameter of more than 6 mm, and evolution (...
• [7] Fair skin that sunburns easily. Lightly pigmented irides (blue and green eye color). Presence of freckles in sun-exposed skin. Poor ability to ...
• [10] These scars can feel firm or rubbery to the touch, and present with symptoms of pruritus (itching), pain and stiffness. There's also a risk of contracture ...

Diagnostic Tests for Burn Scar-Related Melanoma

Burn scar-related melanoma, also known as Marjolin's ulcer or desmoplastic melanoma, is a rare and aggressive form of skin cancer that develops in old scars, burns, or non-healing wounds. Diagnosing this type of melanoma can be challenging due to its hypopigmented appearance and rarity.

Diagnostic Tests

Several diagnostic tests are used to diagnose burn scar-related melanoma:

• Biopsy: A biopsy is the most definitive test for diagnosing burn scar-related melanoma. It involves removing a sample of tissue from the affected area, which is then examined under a microscope by a pathologist.
• Sentinel Node Biopsy: This test is used to check if the melanoma has spread to the lymph nodes in the nearby area. A small sample of tissue is removed from the nearest lymph node and examined for cancer cells (see [9] for more information).
• Imaging Tests: Imaging tests such as ultrasound, CT scans, or MRI scans may be used to determine if the melanoma has spread to other parts of the body.
• Full Medical History: A thorough medical history is essential in diagnosing burn scar-related melanoma. The doctor will gather information about the patient's personal and familial medical history (see [8] for more information).

Other Tests

In addition to these diagnostic tests, a skin cancer screening exam may also be performed to check for signs of actinic keratoses (precancers), basal cell, and squamous cell cancers.

References:

• [1] HB Lee et al. reported a case of malignant melanoma on a burn scar with regional metastasis.
• [4] AF JERANT et al. mentioned the differential diagnosis of pigmented lesions, which includes burn scar-related melanoma.
• [6] The development of malignant melanoma in an old burn scar is an extremely rare event and only six reports could be found in the literature (JH Stilwell).
• [8] To diagnose desmoplastic melanoma, the doctor gathers the patient's full medical history, both personal and familial.
• [9] A sentinel node biopsy may also be performed to check if the melanoma has spread elsewhere in the body.

Treatment Options for Burn Scar-Related Melanoma

Burn scars can increase the risk of developing skin malignancies, including melanoma. While there are various treatment options available, the most effective approach depends on the size and location of the cancer.

• Topical medications: These may be used to treat small, superficial lesions (1).
• Surgical interventions: Mohs surgery is a common treatment for Marjolin Ulcers, which can develop in burn scars (6). This procedure involves removing the cancerous tissue layer by layer.
• Immunotherapy and targeted therapy: Medications like checkpoint inhibitors and BRAF inhibitors may be prescribed to treat melanoma (15).
• Chemical peels: These can be used to treat actinic keratosis, a condition that can develop in burn scars (5).

New Developments in Melanoma Treatment

In recent years, the Food and Drug Administration (FDA) has approved several new drugs for treating melanoma. These include immunotherapy agents like ipilumumab, pembrolizumab, and nivolumab, as well as targeted therapy drugs such as BRAF inhibitors (10).

Combination Therapy

Some studies have explored the use of combination therapies to treat burn scar-related melanoma. For example, a patient was treated with Rejuran S sessions and cross-linked hyaluronic acid, resulting in improved skin revitalization and scar appearance (11).

Early Detection and Intervention

Early detection of skin cancer in burn scars is crucial for effective treatment and better outcomes. Staying informed about available treatment options can significantly improve patient care (12).

The differential diagnosis for an obsolete old burn scar-related melanoma of the skin includes:

• Squamous cell carcinoma: This is the most common type of cancer to arise in burn scars, and it can be difficult to distinguish from melanoma based on appearance alone [9].
• Basal cell carcinoma: Another type of skin cancer that can occur in burn scars, basal cell carcinoma typically presents as a small, shiny bump or nodule [8].
• Recurrent cutaneous squamous cell carcinoma at the site of a previously excised carcinoma: In some cases, melanoma may arise from a pre-existing squamous cell carcinoma that has been previously treated [8].
• Benign tumors: Other benign growths, such as keratoacanthomas or pyogenic granulomas, can also be considered in the differential diagnosis for burn scar-related melanoma [9].

It's worth noting that the diagnosis of melanoma arising from a burn scar can be challenging and often requires a combination of clinical evaluation, histopathological examination, and molecular testing to confirm [10].