Burn scar pleomorphic sarcoma—case report
Daniel Francisco Mello
Karen Chicol Gonçalves
Received: 10 December 2010 /Accepted: 17 May 2011 /Published online: 4 June 2011
Malignant transformation in burn scars was formally
described by Jean-Nicholas Marjolin in 1828, although
there are reports that this phenomenon had been first noted
by Celsus in the first century A.D. The term Marjolin’s
ulcer (MU) is used to denote the malignancies, predomi-
nantly squamous cell carcinomas, which develop in scars
and chronic wounds [1–3].
The burned area, especially those which healed by
secondary intention, is at risk of injury by daily activities
because their coverage differs from normal skin, with
reduced elasticity and hydration. The main factors that
predispose to malignant transformation are: time of evolu-
tion, injury and constant irritation, chronic infection, poor
hygiene habits, and environmental factors [1–3].
The percentage of scars that progress to malignancy is
estimated at 2%, where squamous cell carcinoma is the
most common histological type, followed by basal cell
carcinoma and melanoma. Sarcomas, however, are rarely
described [4–8]. The aim of this paper is to report a case of
undifferentiated pleomorphic sarcoma in a burn scar treated
at our service.
A 54-year-old female patient presented with an ulcer to
the right of her back with 6 months of clinical evolution.
She presented with a history of burns caused by fire
47 years earlier with a skin graft having been performed
after 6 years to correct the scars (41 years earlier). The
patient had a clinical history of hypertension, smoking,
and alcohol abuse.
The examination revealed an ulcerated lesion measur-
ing approximately 7×8×5 cm located to the right of her
back with central necrosis and an eczematous aspect at
its boundaries. Extensive and deep hardening in the areas
adjacent to the tumor was palpable having an overall
diameter of around 15 cm (Fig. 1). No clinical signs of
metastatic lymph nodes in the axillary or inguinal regions
An incisional biopsy showed an undifferentiated sarco-
ma. Additional staging was performed by chest radiogra-
phy, CT of chest (Fig. 2), abdomen and pelvis revealed no
other local changes or evidence of distal metastasis.
A wide local resection of the lesion was performed
with a 2-cm margin demarcated from the lateral limits
estimated by palpation, and deep margin including the
latissimus dorsi and trapezius muscle (Fig. 3). The
coverage was achieved using partial thickness skin grafts
taken from the thighs.
The pathological examination showed: spindle cell sarco-
ma of a high grade (Trojani grade III) of 11×7×5.5 cm, the
presence of perineural infiltration, over 50% of areas with
necrosis, and mitoses in nine out of ten high magnification
fields (Fig. 4). All surgical margins were free of neoplasia.
Even after immunohistochemistry (vimentin +, actin +,
desmin −, EMA +, S100 protein −, HMB45 −,CD34−), a
specific histological subtype was not characterized with the
final diagnosis confirmed as an undifferentiated pleomorphic
sarcoma (Figs. 5 and 6).
The patient had an uneventful postoperative recovery
and total skin graft integration. She is being followed-up on
a regular basis, including clinical examination every
D. F. Mello (*)
K. C. Gonçalves
Department of Plastic Surgery, Santa Casa de São Paulo,
Rua Canuto do Val, 88-AP 183,
Vila Buarque CEP 01224–040, São Paulo, Brazil
Eur J Plast Surg (2012) 35:617–620