MALIGNANT
MELANOMA BY
ARISING
IN AN UNSTABLE
BURN
SCAR
F.R.C.S. J. D. NANCARROW,
West Midlands Regional Plastic Surgery Centre, Wordsley Hospital, Wordsley, Stourbridge, Worcs., England
A 44-YEAR-OLDNURSEburned her left hand over the hypothenar eminence with a hot iron. The burn healed spontaneously over a period of a few weeks. Four years later the scar began to break down and after 2 years of ulceration she was referred for excision and grafting. There was then no evidence of tumour formation and her name was placed on the waiting list. Six months later, i.e. 64 years after the burn, she was urgently referred by her general practitioner because of the tumour shown in Figures I and 2. This proved to be a malignant melanoma of a particularly aggressive kind and she died of metastases 16 months later. DISCUSSION This is only the third instance of a malignant melanoma arising in a burn scar. Gellin and Epstein (1975) described one as did McGovern (1976). Two points would seem important : Firstly, any unstable burns scars should be excised and grafted and the excised tissue should be examined histologically; Secondly, there may be medico-legal implications and indeed, the case reported by Gellin and Epstein was a precedent case in the State of California and a court pronounced that “Melanoma arose as a direct result of the occupational burn”. I would like to thank Mr R. T. Routledge for allowing me to publish this case, and also thank both Mr Routledge and Mr D. C. Bodenham for their comments and advice.
REFERENCES Malignant melanoma from thermal burn scar. G. A. and EPSTEIN, W. L. (1975). Archives of Dermatology, 3, 1214. MCGOVERN, V. J. (1976). Malignant melanoma: clinical and histological diagnosis. New York, London, Sydney, Toronto: John Wiley & Sons. GELLIN,
MELANOMA BY
ARISING
IN AN UNSTABLE
BURN
SCAR
F.R.C.S. J. D. NANCARROW,
West Midlands Regional Plastic Surgery Centre, Wordsley Hospital, Wordsley, Stourbridge, Worcs., England
A 44-YEAR-OLDNURSEburned her left hand over the hypothenar eminence with a hot iron. The burn healed spontaneously over a period of a few weeks. Four years later the scar began to break down and after 2 years of ulceration she was referred for excision and grafting. There was then no evidence of tumour formation and her name was placed on the waiting list. Six months later, i.e. 64 years after the burn, she was urgently referred by her general practitioner because of the tumour shown in Figures I and 2. This proved to be a malignant melanoma of a particularly aggressive kind and she died of metastases 16 months later. DISCUSSION This is only the third instance of a malignant melanoma arising in a burn scar. Gellin and Epstein (1975) described one as did McGovern (1976). Two points would seem important : Firstly, any unstable burns scars should be excised and grafted and the excised tissue should be examined histologically; Secondly, there may be medico-legal implications and indeed, the case reported by Gellin and Epstein was a precedent case in the State of California and a court pronounced that “Melanoma arose as a direct result of the occupational burn”. I would like to thank Mr R. T. Routledge for allowing me to publish this case, and also thank both Mr Routledge and Mr D. C. Bodenham for their comments and advice.
REFERENCES Malignant melanoma from thermal burn scar. G. A. and EPSTEIN, W. L. (1975). Archives of Dermatology, 3, 1214. MCGOVERN, V. J. (1976). Malignant melanoma: clinical and histological diagnosis. New York, London, Sydney, Toronto: John Wiley & Sons. GELLIN,
