Unusual explosive growth of a squamous cell carcinoma of the scalp after electrical burn injury and subsequent coverage by sequential free flap vascular connection – a case report

This report presents the case of a 63-year-old man with chronic ulceration of a postburn scar of the scalp due to an electrical burn 58 years ago. Sudden tumour growth started within weeks and on presentation already had extended through the skull into frontal cortex. After radical tumour resection, defect was covered with a free radial forearm flap. Local recurrence occurred 6 weeks later. Subsequent wide excision including discard of the flap and preservation of the radial vessels was followed by transfer of a free latissimus dorsi muscle flap, using the radial vessels of the first flap as recipient vessels. The patient received radiotherapy post-operatively. There were no problems with flap survivals or wound healing. Due to rapidly growing recurrence the patient died 2 months later.Explosive SCC tumour growth might occur in post-burn scars after more than 50 years. As a treatment option the use of sequential free flap connections might serve in repeated extensive tumour resections, especially in the scalp region, where suitable donor vessels are often located in distance to the defect.Malignant degeneration of burn scars has been reported as early as in the first century by Celsus. However, the classic description was published by Jean-Nicholas Marjolin in 1828, who indeed did not regard the lesion as malignant [1]. The entity ？Marjolin's ulcer“, which is commonly used for carcinoma arising in post-traumatic scars, has been applied ever since the report of Da Costa in 1903, who first used the term [2]. Today the term "Marjolin's ulcer" is generally used for squamous cell carcinoma arising in posttraumatic scars. However squamous cell carcinoma has recently been reported to arise also from other skin lesions such as Fournier's gangrene[3]. There have been some case reports of burn scar carcinomas of the scalp [4-6], a localization not as common as the lower extremity but still making up approximately 14% of burn scar carcinomas[7]. Due to involvement of the skull