Skin Cancer and Wound Healing
Summary: This editorial explores the intersection of skin cancer and wound healing, noting that basal cell carcinoma (BCC)—the most common skin cancer—often presents with erosions or ulcerations on sun-exposed skin. Treatment includes excision, curettage, or Mohs microsurgery for facial/larger lesions. A case of a massive (18 × 16.5 cm) shoulder/scapular BCC required vismodegib (Hedgehog inhibitor), radiation, and extensive surgery after secondary infection. Marjolin ulcers (malignant transformation, usually to squamous cell carcinoma/SCC in chronic scars/wounds like burns, pressure injuries, or osteomyelitis sites) are aggressive, with a classic triad of deep nodule, indurated edges, and central ulceration. They carry 20-40% risk of regional lymph node spread and higher mortality; early and repeated biopsies are critical due to sampling error. Two additional cases in the issue illustrate Marjolin SCC in a tibial malunion/osteomyelitis site and a sacral pressure injury. Recommendations include total skin exams for patients with prior skin cancers, vigilance in dark skin tones and high-risk groups (immunosuppressed, hidradenitis suppurativa), foot exams for melanoma, and sun protection (SPF 30-60, wide-brim hats, vitamin D supplementation).
Key Highlights:
- BCC may ulcerate; advanced cases benefit from vismodegib + radiation/surgery (only 1-10% are locally advanced)
- Marjolin SCC in chronic wounds/scars is aggressive with 20-40% nodal metastasis risk; biopsy nonhealing ulcers (repeat if suspicion high)
- Case examples: large BCC requiring multimodal therapy; Marjolin in pressure injury and osteomyelitis sites
- Prevention: sun protection, total skin exams, foot checks (especially in persons of color)
- Authors: R. Gary Sibbald, Elizabeth A. Ayello
Keywords: skin cancer wound healing, Marjolin ulcer, basal cell carcinoma, R. Gary Sibbald