This registry was not nationwide until 1987.
CHEMICAL BURN SCAR REGISTRATION
For each discharge, date of admission, date of discharge, main and up to 5 contributory discharge diagnoses (coded according to ICD 7: 1964–1968, ICD 8: 1968–1986 and ICD 9 thereafter), surgical procedures, department and hospital are recorded, together with the individual’s national registration number. Since 1964, the Swedish National Board of Health and Welfare has compiled data on individual hospital discharges in the national Inpatient Registry. This study was approved by the Ethics Committee at the Karolinska Institute, Stockholm, Sweden. The patients were followed-up for 39 years.
CHEMICAL BURN SCAR SKIN
We aimed to estimate the risk for skin cancer in a population-based cohort of 37,095 Swedish patients hospitalized for burn injuries. This finding is surprising in the light of the clinical descriptions of a tendency of malignant degeneration of burn scars (2). In contrast to what has been reported for a long time, no increased risk of any type of skin cancer was found. Recently, the first population-based epidemiological study was published, comprising 16,903 Danish patients admitted to a hospital for burns and followed-up in the national cancer registry for up to 25 years (6). These include a role of inflammation and irritation in precipitating a cancer, hereditary factors, tissue toxins and co-carcinogens released by the burn, poor vascularization and no lymphatic channels in scars resulting in impaired immunological defence (2–5). While the factors governing malignant transformation, subsequent recurrence and metastatic spread are not completely understood, several hypotheses have been offered. Furthermore, the mean latency interval between the burn and malignancy was 31 years (2). Seventy-one percent of the tumours were squamous cell carcinoma (SCC), 12% were basal cell carcinoma (BCC), 6% were malignant melanoma (MM), 5% were sarcoma and 6% were other neoplasms. Of these, 412 case reports could be analysed in detail. Recently an exhaustive review summarized 146 articles between 19, including 1078 cases (2). Voluminous reports on burn scar neoplasms have continued to appear, usually in the form of case reports. The association between malignancies and burn scars, chronic ulcers, and wounds has subsequently been established ever since the turn of the 19th century. They are also called Marjolin’s ulcers, after Jean-Nicolas Marjolin who first described the development of skin carcinoma in old burn scars in 1828 (1). E-mail: scar carcinomas, are uncommon tumours that have been reported to arise from an antecedent burn. Key words: skin cancer burns epidemiology cohort.īernt Lindelöf, Department of Dermatology, Karolinska University Hospital, S-171 76 Stockholm, Sweden. This study does not support any casual association between burn injuries and a later risk of skin cancer.
Also, in a subgroup of 12,783 patients who were followed for 20–39 years, no increased risk of skin cancer could be detected. However, squamous cell carcinoma: SIR 0.88 (95% CI 0.70–1.09) and malignant melanoma: SIR 0.88 (95% CI 0.68–1.12) did not occur more often than expected. The risk of developing any form of cancer was slightly increased: standardized incidence ratio (SIR) 1.11 (95% confidence interval (CI) 1.06–1.16) based on 2227 patients with cancer. The mean follow-up time was 16.4 years (range >0–39). This cohort was linked with the Swedish Cancer Registry for a virtually complete follow-up with regard to cancer. Using the national Inpatient Registry we identified 37,095 patients who had been hospitalized for burn injuries. We conducted a historical cohort study to assess the risk of cancer in Swedish patients with burn injuries. Only one epidemiological study has been performed recently, but it could not confirm any increased risk.
CHEMICAL BURN SCAR SERIES
A large number of case reports and small series of selected patients have been published.
The interval between the initial burn and the diagnosis of the tumour is usually long 20–30 years or more. Most of these tumours are squamous cell carcinoma and, more occasionally, basal cell carcinoma and malignant melanoma are reported. Development of malignant tumours in chronic burn wounds or scars is extremely rare, but a frequently reported complication.
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