A case of squamous cell carcinoma occurring on a scar of Buruli ulcer in Bouake, Ivory Cost

Abstract

Buruli ulcer is infectious necrotizing panniculitis due to Mycobacterium ulcerans. Buruli ulcer is healed by leaving dystrophic, fibrous and retractile scars. On these scars can occur long-term squamous cell carcinoma. We report the first case of squamous cell carcinoma occurring on healing of Buruli ulcer. A 32-year-old woman with Buruli ulcer who has been cured for about 10 years is seen for ulcero-bulging knee swelling. The examination had revealed a large swelling of about ten centimeters in diameter, ulcero-budding, with an easily bleeding cauliflower appearance. The diagnosis of squamous cell carcinoma being retained without metastasis, resection of the tumor with scarring after one month without chemotherapy. There was no recurrence after six months of decline. The epidemiology of Buruli ulcer, responsible for scarring, explains the young age of our patient and the localization of carcinoma on the limb. The carcinomatous degeneration of scars, especially the scars of old burns, is constantly reported. The characteristics of Buruli ulcer scars, which bring them closer to burn scars, may explain why they are particularly affected by carcinomatous degeneration. One could also mention the chronicity of the wound in this infection, or wonder if the mycobacteria itself could play a role in carcinogenesis. This observation is, in our opinion, an alarm signal. We must fear an outbreak of cases in the years to come. To this end, preventive measures should already be taken by sensitizing the patients for an early consultation before any modification of their scars. After recovery, Buruli ulcer seems to present a risk of long-term evolution to a cancer. The scars of this condition, which could be considered precancerous lesions.

Invasive squamous cell carcinoma on sternotomy scar

“…Additionally, it is assumed that sun exposure could play a significant role in squamous carcinoma growth in individuals with fair skin like our patient; however, other factors that result in chronic ulcers like infectious, discoid lupus erythematosus, and HIV infection could be responsible in the individuals with darker skin. 6 Generally, these Marjolin ulcers have been categorized into acute and chronic types depending on the time period between the first injury and the malignancy appearance on the injured skin. A recent investigation revealed that the average duration for this process is approximately 5 years.…”

“…1 The pathogenesis of these chronic types could be related to the ongoing insults and irritations to the scar tissue associated with the lack of vascularization, resulting in decreasing the local immunity of the area and the tumor growth. 6 F I G U R E 1 An ulcerated nodule on the middle line of the chest, exactly in the middle of his sternotomy scar, with 3-cm diameter.…”

“…Additionally, it is assumed that sun exposure could play a significant role in squamous carcinoma growth in individuals with fair skin like our patient; however, other factors that result in chronic ulcers like infectious, discoid lupus erythematosus, and HIV infection could be responsible in the individuals with darker skin. 6 …”

“…The pathogenesis of these chronic types could be related to the ongoing insults and irritations to the scar tissue associated with the lack of vascularization, resulting in decreasing the local immunity of the area and the tumor growth. 6 …”

Exploiting reductive evolution in Mycobacterium ulcerans to develop a single-dose cure for Buruli ulcer

“…Scarring can lead to disfigurement, impaired mobility, and reduced elasticity making it more prone to cracking and injuries 76 . A rare complication is the development of squamous cell carcinoma at scar site 85,86 .…”