Indian Journal of Radiology and Imaging Indian Journal of Radiology and Imaging

MUSCULOSKELETAL
Year
: 2005  |  Volume : 15  |  Issue : 4  |  Page : 467--468

Images : Squamous cell carcinoma of hand and wrist developing in burn scar


SV Phatak, PK Kolwadkar 
 Kolwadkar X Ray clinic, Wardha road, Ramdaspeth, Nagpur 440012, India

Correspondence Address:
S V Phatak
101,Vijay Arcade; 16 North ambazari road, Shankar nagar chowk, Nagpur 440012
India




How to cite this article:
Phatak S V, Kolwadkar P K. Images : Squamous cell carcinoma of hand and wrist developing in burn scar.Indian J Radiol Imaging 2005;15:467-468


How to cite this URL:
Phatak S V, Kolwadkar P K. Images : Squamous cell carcinoma of hand and wrist developing in burn scar. Indian J Radiol Imaging [serial online] 2005 [cited 2020 May 26 ];15:467-468
Available from: http://www.ijri.org/text.asp?2005/15/4/467/28775


Full Text

 Introduction



Malignant tumors of hand are categorized into primary and metastatic. Primary malignant tumors include skin tumors, musculoskeletal tumors and /or soft tissue tumors. While malignant hand tumors are relatively uncommon, the incidence of metastatic tumors is exceedingly rare. The lungs.kidneys head and neck are the most common sites causing metastasis to the hand. Squamous cell carcinoma is most common primary malignant tumor of hand accounting for 75-90%of hand malignancies. The Male: Female ratio is 2-5:1.Risk factors are x ray exposure, chronic ulcers, immunosupression, sun exposure, Bowens disease and xeroderma Pigmentosa. Tumors often manifest as small firm nodules with indistinct margins or plaques. The surface may have various irregularities ranging from verruciform to ulcerated. Typically squamous cell carcinoma is locally invasive however metastatic rates upto 20% have been reported in radiation beds and burn scars [1]

 Case report



A twenty eight-year-old patient presented with ulcerative growth on right hand and wrist with previous history of burn in same area ten bears back. On examination ulcerative growth was present. Routine hematological investigations and chest radiograph was normal. No lymphadenopathy was present on clinical examination. Radiograph, CT and MRI of hand were done to know involvement of soft tissues and bones. Biopsy of ulcer indicated squamous cell carcinoma.

 Discussion



In 1928,Jean Nicholas Marjolin first described carcinoma arising in posttraumatic scars. So classic was his descriptions that the term Marjolin 's ulcer has since been applied to malignant changes occuring in chronic ulcers of skin, sinuses or previous burn scars. [2] The precise mechanism by which chronic ulcers (wounds) develop malignancy is not certeain but chronic irritation and infection with resulting degeneration and regeneration may be instrumental in malignant transformation of either epithelial or sarcomatous type [3] Multiple modalities are available for diagnostic imaging of potentially malignant hand lesions. Images from plain radiographic studies offer a good degree of bony definition.with possible bony involvement of a lesion. . If findings of bony invasion are equivocal on plain radiographic images CT is the next logical step in assessing the lesion. MRI has a distinct advantage over CT with improved resolution in soft tissue imaging. MRI has been used to determine the area of gross involvement to better define lesions prior to operative intervention. Bone scans are useful in finding hot spots or areas of increased radioisotope uptake. At times ultrasound can be useful to know whether lesion is solid or cystic. [1] MRI is superior to CT for demonstrating the extent of medullary bone, soft tissue and neurovascular involvement. Most frequently both T1 and T2 weighted images are needed to characterize the lesions. T2 Weighted images are best suited for soft tissue characterization and T1weighted images for distinction between marrow and tumor. STIR sequences are useful for detection of subtle marrow or soft tissue lesions. To date gadolinium has not significantly improved histologic accuracy of MRI except for differentiating solid from cystic lesions and identifying areas of necrosis. [4]

References

1Benjamin W Beckert et al Hand, Tumors: Malignant e medicine specialities plastic surgery Hand last updated April 24,2003.
2Robert M.Lifeso, Colin A Bull Squamous cell carcinoma of the extremities Cancer June 1985 vol.55, No.12: 2862-2867.
3Julius Smith et al Malignancy in chronic ulcers and scars of leg (Marjolins ulcer) a study of 21 patients Skeletal Radiology 2001; 30:331-337.
4Thomas H Berquist MRI of musculoskeletal system Lippincott Williams and Wilkins, 4th edition 2001:827.