Cutaneous melanoma arising in a burn scar: two recent cases and a review of the literature

Malignant melanoma arising in a burn scar

Secondary malignancies are rare but devastating complications of longstanding burn scars. Squamous cell carcinoma is the most common, followed by basal cell carcinoma and melanomas. There are fewer than 50 total reported cases of malignant melanomas arising in burn scars. We report a case of malignant melanoma arising within a longstanding burn scar confirmed by histology, FISH, and PRAME staining to further characterize melanomas arising in burn scars and to illustrate the diagnostic challenges they present.

Multiple melanoma in a burns scar

It is well known that up to 2% of chronic burn scar lesions can transform into malignant tumours, however, melanoma formation at these sites is extremely rare. This case report describes a burns case, which progressed to four melanomas in a 78-year-old male patient’s little finger, 40 years after the initial incident. The patient underwent 3 mm punch biopsies, then digital amputation of the finger with pathology-proven melanoma. Histopathology investigation demonstrated three melanoma in situ and one invasive melanoma with a Breslow thickness of 1 mm. These findings are rare with few reports of melanoma in burn scars in the literature. This case report highlights the vigilance required from clinicians when performing skin examinations, and the importance of biopsies to newly pigmented lesions.

Genital melanocytic nevus arising in a background of lichen sclerosus in a 7-year-old female: the diagnostic pitfall with malignant melanoma. A literature review

Genital melanocytic nevus represents a distinct form of melanocytic proliferation, which can exhibit significant atypia, both clinically and histologically. In a background of lichen sclerosus (LS), the histologic changes could be misconstrued as indicative of malignant melanoma. We present herein a case of the atypical genital nevus of childhood complicated by LS, and a review of the literature is performed. Tissue was available for routine light microscopy and immunohistochemical evaluation to assess the expression of soluble adenylyl cyclase. Fluorescent in situ hybridization studies were conducted to assess for abnormalities in Myb1, CCND1, RREB1 and CEP6. The specimen showed an atypical compound melanocytic proliferation arising in a background of LS. The lesion exhibited significant architectural atypia based on the high-density confluent nature of the junctional melanocytic proliferation with epidermal effacement, rare areas of pagetoid ascent, and the heavily pigmented epithelioid quality of the melanocytes. Fluorescent in situ hybridization studies were normal. The soluble adenylyl cyclase antibody preparation demonstrated a benign nevus-like pattern. The lesion was felt to represent an atypical genital melanocytic nevus, which can resemble a partially regressed melanoma in a background of LS. It is very important for the pathologist to be aware of this entity to avoid misdiagnosis.

The association between trauma and melanoma in the Chinese population: a retrospective study

BACKGROUND

The association between trauma and melanoma has been a controversial issue.

OBJECTIVES

To analyse the profiles of melanoma, and to determine whether trauma is associated with development of acral melanoma in the Chinese population.

PATIENTS AND METHODS

Retrospective analysis of 685 cases of cutaneous melanoma in the dermatology departments of Xijing Hospital in northwestern China and Xinan Hospital in southwestern China from 1982 to 2011.

RESULTS

Of the 685 patients included in the study, 437 (63.8%) suffered from melanoma on the extremities. A total of 104 patients (15.2%) exhibited an association between trauma and melanoma. The primary anatomic sites of the tumours were the upper extremities (17, 16.3%), lower extremities (74, 71.2%) and other sites (13, 12.5%). Among these cases, the extremities were with remarkably higher risks of post-trauma melanoma than the other sites [adjusted odds ratio (OR) 3.968; 95% confidence interval (CI) 2.267-5.592]. Notably, patients in the south part of China were with a stronger risk of post-trauma melanoma on the lower extremities than those in the north (adjusted OR 1.764; 95% CI 1.192-2.666) part. In addition, a significant higher risk of post-trauma melanoma on the extremities was observed in the male gender (adjusted OR 1.848; 95% CI 1.186-2.887).

CONCLUSIONS

Our findings provide epidemiological evidence for a potential association between traumatic events and melanoma of the extremities, especially the lower limbs, where a history of trauma is more likely.