Letter - Clinical
Amelanotic nodular melanoma in Marjolin ulcer on the plantar region
Valentina Lourenço Lacerda de Oliveira
, Lucia Martins Diniz, Karla Spelta, Elton Almeida Lucas
Corresponding author
Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
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Bilateral ulcerations on the distal phalanges of the second and third fingers - Ulcerative carpal tunnel syndrome" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "531" "paginaFinal" => "533" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1709 "Ancho" => 2508 "Tamanyo" => 265447 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical aspect. 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Clinical</span>" "titulo" => "Amelanotic nodular melanoma in Marjolin ulcer on the plantar region" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "529" "paginaFinal" => "531" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Valentina Lourenço Lacerda de Oliveira, Lucia Martins Diniz, Karla Spelta, Elton Almeida Lucas" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Valentina Lourenço Lacerda" "apellidos" => "de Oliveira" "email" => array:1 [ 0 => "valentinalloliveira@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Lucia Martins" "apellidos" => "Diniz" ] 2 => array:2 [ "nombre" => "Karla" "apellidos" => "Spelta" ] 3 => array:2 [ "nombre" => "Elton Almeida" "apellidos" => "Lucas" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitória, ES, Brazil" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1149 "Ancho" => 2508 "Tamanyo" => 457100 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0070" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(a) Ulcerated lesion with cell proliferation occupying the superficial and deep dermis. (b) Moderately pleomorphic, fusiform and epithelioid cells, with hyperchromatic nuclei; nucleoli are difficult to distinguish.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">This case describes an 80-year-old female Caucasian patient, who sought dermatological evaluation for a lesion on the left foot after local trauma, with progressive growth over two years. Dermatological examination showed a nodular, vegetating, tumor-like lesion covered by hematic crusts on the left plantar region, overlapping an extensive area of deformities in the foot anatomy, caused by healing by secondary intention of burn lesions that occurred in childhood (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Histopathology showed an ulcer filled with a fusiform cell proliferation arranged in bundles in different directions, occupying the superficial and deep dermis, and moderate cell pleomorphism (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Immunohistochemistry was positive for S-100 protein, gp100 and Melan-A, confirming the diagnosis of melanoma (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The association of clinical and laboratory findings led to the diagnosis of acral amelanotic nodular melanoma on a burn scar. The authors found in the literature four case reports of amelanotic melanoma arising on chronic scars when searching Pubmed using the terms “burn and amelanotic melanoma” and “Marjolin ulcer and amelanotic melanoma”, demonstrating the rarity of such a presentation.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The lesion was completely excised, as well as the ipsilateral lymph nodes, after confirmation of a positive sentinel lymph node for metastatic melanoma. Imaging exams showed alterations suggestive of metastasis in face and skull bones. The patient died after eight months.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Marjolin ulcer is a rare and aggressive tumor, occurs mainly in the fifth decade of life, and is prevalent in the male sex.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It arises over scar tissue, particularly after burns, occurring in 0.7% to 2% of these lesions.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> Clinically, the lesions arise over previous scarring, as a non-healing, ulcerated or hardened, rapidly growing lesion that may become exophytic and bleeding. The most frequent histopathological type of neoplasia arising in Marjolin ulcers is squamous cell carcinoma (80%–90%), followed by basal cell carcinoma (9.6%) and, rarely, melanoma (2.4%).<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> The low incidence of melanoma in these scars can be explained by the small number of melanocytes in the scar tissue.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In the epidemiology of melanomas, the nodular type represents the second most frequent one (approximately 15% of diagnosed melanomas), and 5% of nodular melanomas are amelanotic.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Amelanotic acral melanoma has an incidence of 1.8% of melanoma cases,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and sometimes manifests as hyperkeratotic lesions.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The diagnoses of Marjolin ulcer and melanoma are defined by clinical history, physical examination, and histopathology. The therapeutic options depend on TNM staging, including excision surgery with wide margins or limb amputation, in addition to chemotherapy and radiotherapy.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Scars are susceptible to trauma due to a lack of collagen organization and vascular supply compromised by fibrosis, which obstructs vessels. Virchow's theory attributes the development of malignancy in scars to repeated trauma in the area, which leads to chronic irritation, repeated re-epithelialization, and local damage to the skin immune system, with a reduction in Langerhans cells and production of toxins in the affected area, in addition to genetic predisposition.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">A rare manifestation of Marjolin ulcer is presented in this case, which presented as a nodular acral amelanotic melanoma, reinforcing the need for advice to patients, care, and regular follow-up of burn scars, for early diagnosis and treatment, reducing morbidity and mortality.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0045" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors' contributions</span><p id="par0050" class="elsevierStylePara elsevierViewall">Valentina Lourenço Lacerda de Oliveira: Design and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of data; critical review of the literature; critical review of the manuscript.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Lucia Martins Diniz: Approval of the final version of the manuscript; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the manuscript.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Karla Spelta: Intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the manuscript.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Elton Almeida Lucas: Intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors' contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-07-26" "fechaAceptado" => "2021-08-28" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitória, ES, Brazil.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1110 "Ancho" => 3008 "Tamanyo" => 165716 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0065" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(a) Anatomical deformity in the left foot and absence of toes, secondary to a burning accident in childhood, that healed by second intention. (b) Vegetating nodular-tumor lesion with hematic crusts, well-defined borders, blackened spots, and overlying keratosis, affecting the plantar region and lateral face of the left foot.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1149 "Ancho" => 2508 "Tamanyo" => 457100 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0070" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(a) Ulcerated lesion with cell proliferation occupying the superficial and deep dermis. (b) Moderately pleomorphic, fusiform and epithelioid cells, with hyperchromatic nuclei; nucleoli are difficult to distinguish.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1244 "Ancho" => 1675 "Tamanyo" => 261379 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0075" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Immunohistochemistry was positive for Melan-A monoclonal antibody, which recognizes a specific melanocytic differentiation protein expressed in benign and malignant melanocytes.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Melanoma Marjolin’s ulcer in the hand: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R.P. Serras" 1 => "D.C. Rasteiro" 2 => "M.M. Mendes" 3 => "M.M. Mouzinho" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int J Surg Case Rep." "fecha" => "2019" "volumen" => "60" "paginaInicial" => "345" "paginaFinal" => "347" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Marjolin Ulcer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Shah" 1 => "J.S. Crane" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2021" "editorial" => "StatPearls Publishing" "editorialLocalizacion" => "Treasure Island" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Marjolin ulcer: a comprehensive review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K. Khan" 1 => "C. Schafer" 2 => "J. Wood" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.ASW.0000722216.64735.c9" "Revista" => array:5 [ "tituloSerie" => "Adv Skin Wound Care." "fecha" => "2020" "volumen" => "33" "paginaInicial" => "1" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33208668" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A rare case of acral amelanotic melanoma, nodular type" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D.M. Saeed" 1 => "M. Braniecki" 2 => "J.V. Groth" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/iwj.13212" "Revista" => array:6 [ "tituloSerie" => "Int Wound J." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 27 | 10 | 37 |
| 2024 October | 132 | 84 | 216 |
| 2024 September | 159 | 77 | 236 |
| 2024 August | 168 | 128 | 296 |
| 2024 July | 167 | 118 | 285 |
| 2024 June | 132 | 77 | 209 |
| 2024 May | 132 | 57 | 189 |
| 2024 April | 100 | 90 | 190 |
| 2024 March | 114 | 75 | 189 |
| 2024 February | 103 | 88 | 191 |
| 2024 January | 67 | 56 | 123 |
| 2023 December | 72 | 56 | 128 |
| 2023 November | 66 | 83 | 149 |
| 2023 October | 81 | 74 | 155 |
| 2023 September | 79 | 88 | 167 |
| 2023 August | 69 | 31 | 100 |
| 2023 July | 192 | 82 | 274 |
| 2023 June | 44 | 37 | 81 |
| 2023 May | 42 | 26 | 68 |
| 2023 April | 44 | 21 | 65 |
| 2023 March | 34 | 37 | 71 |
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