Multiple squamous cell carcinoma of the upper limb originating from long-standing burn scars: A case report

Background

Squamous cell carcinoma (SCC) arising from long-standing burn scars—Marjolin's ulcer—is rare but aggressive. Multiple synchronous SCCs in burn scars are exceptionally uncommon and associated with rapid progression.

Case presentation

A 56-year-old male with a 40-year-old thermal injury to the right upper limb presented with two enlarging masses over the elbow and axilla. Initial cytology suggested benign dermoid cysts, but MRI indicated suspicious heterogeneous lesions. Excision with axillary lymphadenectomy revealed well-differentiated SCC with extensive nodal metastases and positive margins. Within one month, rapid multifocal recurrence and cervical lymphadenopathy required right upper limb amputation with cervical lymphadenectomy, followed by adjuvant radiotherapy. Postoperative care included antibiotic prophylaxis, multimodal analgesia, early physiotherapy, and psychological counseling. The patient expressed that he had never considered his burn scars a cancer risk and hoped his experience would encourage vigilance for chronic wounds.

Discussion

This case underscores the limitations of cytology in evaluating chronic scar lesions and the importance of early biopsy, histopathologic confirmation, and oncologic resection from the outset. Multifocal SCC in burn scars may indicate a high-risk biological profile, warranting aggressive surgical management and structured long-term follow-up.

Conclusion

Clinicians should maintain a high index of suspicion for malignancy in chronic burn scars, avoid relying solely on cytology, and adopt an oncologic surgical approach at first intervention. Lifelong surveillance is essential to detect recurrence or new primary lesions.