[Cancers in the scars of thermal burns (apropos of 67 cases)].

Burns are very frequent. Skin cancer on burns scars are one of the known complications. The mechanisms and the risk factors of this disease are not very well known. To review the risk factors and the mechanisms of transformation of burn scars into cancer, we analyzed 67 retrospective cases of Marjolin's ulcer to describe the epidemiological features of the disease in our practice and identify the factors of relapse. Our patients are young (means age 41), mainly male (54%), with disease localized on arms and legs (88%). The initial burn was from flames (54%), charcoal or hot cooking oil (19.5%) and never from ionizing radiation. It was never a superficial burn and covered from 4 to 37% of the body surface (mean 14%). The initial treatment was medical in only 9% of cases and ended with 85% of complete healing. After 4 to 67 years of evolution, 95% of re-ulceration occurred. Abnormal lymph node and distant metastasis were diagnosed in respectively 68 and 7% of the cases. Amputation and groin dissection were respectively done in 63 and 50%. One third of patients were lost during the follow up. 25% of the cases are still alive and free of disease. We found 30% of local recurrence and 17.5% of regional recurrence. By univariate analysis we found that the factors significantly associated to loco-regional relapse are: male status (p = 0.0327), burns by cooking oil (p = 0.0118), lack of treatment during initial burn (p = 0.0001), sclerous scar (p = 0.0281), supra regional lymph nodes (p = 0.028) lack of treatment during re ulceration (p = 0.0308). Squamous cell carcinomas on burn scars are rare diseases and of bad prognosis. Mainly associated to domestic accidents they frequently occur on limbs and arms on an articulation. Metastasis is not frequent. Conservative treatment is associated with 30% of recurrence. In our practice, the relapse risk factors are male status, burns by cooking oil, lack of treatment during the initial burn, sclerous scar, supra regional lymph nodes, lack of treatment during re ulceration.