Long-standing Scar Research Articles

A long-standing scar on the abdomen of healthy woman

A long-standing scar on the abdomen of healthy woman

The Impact of the Covid-19 Pandemic on Syrian Refugees and Turkish Citizens in Turkey

There is no doubt that the pandemic has already led to devastating social, economic and political effects that left deep and longstanding scars. In the longer term, we should look at ways to better prevent and manage such crises and ensure that the world makes full use of what we will learn from this one. Therefore studies based on real data on Covid-19 are important to strengthen the fight against the pandemic. This is extremely useful for developing an integrated global response as an investment for our future. For this reason, we carried out this research to explore the relationship between SARS-CoV-2 infection and socio-demographic factors, severity of disease, mortality rates and comorbidity on 26,835 inpatients and 47, 875 outpatients with Covid-19, whom 2066 (7.7% of inpatients) and 2090 (4.4% of outpatients) were Syrian refugees hospitalized and admitted to the outpatient clinics located in 6 different regions of the country, between March 2020 and June 2022. The main objective of this research is to explore the differences of socio-demographic factors, comorbidities, treatment schemes etc. between Syrian refugees and Turkish citizen as well as identified the associations between co-morbidities and clinical outcomes, and its impact on the mortality of inpatients with Covid-19. The research also investigated the frequency of SARS-CoV-2 infection symptoms, the treatment applied, length of stay in ICU and hospital, clinical symptoms and radiological findings, the impact of comorbidity, vaccination status and other factors on the course of Covid-19 diagnosed patients among two different populations. Out of 4.395 Syrian refugees and patients with other nationalities whom diagnosed as Covid-19; 50.7 % are found to be male 49.3 % female among Syrian refugees. The mean age is found to be 33.1 among Syrian refugees while this is 52.5 for Turkish Citizen and the relationship between age groups and nationality is determined statistically significant. Having at least one Covid symptoms is 57% among Syrian refugees while this has been determined as 66.9% among Turkish citizen. It was found that out of 69.815 Turkish citizen 39.1 % and 4.156 Syrian refugees 22.3 % with Covid-19 have co-morbid conditions. It was determined that 11.1% of Syrian patients with COVID-19 were smokers. In Turkish citizen patients, this rate is 8.5%. The mortality rate among Syrian patient was determined as 13.0%, while this amount is 15.1% among Turkish patients.

Marjolin’s ulcer – epidemiology and the pattern of care: Experience from a tertiary cancer care center

Background: Marjolin’s ulcer (MU) reflects the malignant transformation of scar tissue or chronic inflammatory skin lesions. Due to the low incidence, only a few case reports and case series were reported in the literature to date. Aims and Objectives: In our retrospective analysis, we report our experience regarding MU over the past 16 years with a significant range of latent period, histology, and as well as underlying skin conditions, from Kolkata, India. Materials and Methods: This was a single institutional retrospective study carried out in the department of radiotherapy at the tertiary cancer, Kolkata. We focus mainly on data pertaining to the type of injury, the time gap between the initial injury and development of MU, histology, clinical stage, and treatment received, along with demographic details. Results: A total of 39 patients with histopathologically proved MUs were included according to the inclusion and exclusion criteria. The median age of patients at the time of development of MU was 52 years and with a range of 32–71 years. Out of 39 patients who participated in this study, 29 were male (74%) and ten were female (26%), 31 patients have localized disease (80%) and eight patients have metastatic disease (20%). The most common histology is squamous cell carcinoma and the least common histology was spindle cell sarcoma. The majority of the patients were treated with curative intention and a small proportion of patients were offered palliative therapy. Conclusion: Ulcers refractory to basic wound care, chronic in nature, and recent change of character of long-standing scar or wound, diagnosis of MU should be ruled out by biopsy. The management of MU should be supervised by a multidisciplinary tumor board and in the areas of epidemiology and treatment, more research is needed.

Marjolin’s Ulcer Over Post Burn Scar : A Rarity

Marjolin's ulcer (MU) is a cutaneous malignancy that arises over previously injured skin, longstanding scars and chronic wounds. Burn scars are the most common predisposing condition that leads to the development of MU with reported incidence of 0.77 to 2%. Exact etiology for the development of MU is not known. MU is relatively commoner among males than females and affecting all age groups and races. We report a case of Marjolin's ulcer in a 24-year-old woman arising over a long-standing burn scar. Keywords: Tumors, Squamous cell carcinoma, Skin malignancy

Squamous cell carcinoma arising from suprapubic cystostomy: report of two cases and a narrative review of literature

Squamous cell carcinoma arising from Marjolin’s ulcer of the suprapubic cystostomy tract is a rare entity that usually occurs in patients with a history of spinal cord injuries and a chronic indwelling catheter. We present 2 cases of this rare entity with the clinical exams needed for diagnosis and treatment according to individual characteristics of each case. Marjolin’s ulcer is a cutaneous malignancy that arises from injured skin. The most frequent type of malignancy identified on histopathologic examination is squamous cell carcinoma (80-90%). It can develop from long-standing scars, chronic wounds, pressure ulcers, osteomyelitis, and burns. Only cases have been reported about Marjolin’s ulcer with squamous cell carcinoma at the cystostomy cite. Treatment regimens have not been standardized; cases have received individualized treatments, usually with excision, radiation, or a combination of both. There is insufficient evidence to aid in the understanding of the etiology. In addition, there is no consensus on its optimal treatment and follow-up schemes.

Scar Sarcoidosis: A Retrospective Investigation into Its Peculiar Clinicopathologic Presentation

BackgroundScar sarcoidosis (SS), a rare form of cutaneous sarcoidosis, develops from pre-existing scars. Owing to its rarity, the clinicopathologic features and its significance in clinical prognosis have been obscure.ObjectiveThis study aimed to investigate clinical, laboratory and histopathologic findings and to clarify characteristics associated with the development of SS and systemic involvement.MethodsWe retrospectively assessed clinical, laboratory and histopathologic findings of SS. Clinical factors including demographics, anatomic area, number of lesion (single, multiple), presence of symptoms, latent period, injury types related to scar and the proportion of systemic involvement were investigated.ResultsOf the 21 patients with SS, skin lesions appeared predominantly in females (85.7%) and in the head and neck (57.1%). The mean latent period was 163.5 months and 13 patients (61.9%) had multiple lesions. Injury types were varied, with no specific type identified as associated with SS. Histologically, discrete sarcoidal granulomas surrounded by densely packed collagen bundles with a thickening of numerous fibers were observed. Ten patients (47.6%) had systemic involvement and showed significantly more of the multiple lesions, longer latent period and higher level of mean serum angiotensin-converting enzyme than those without systemic involvement.ConclusionVarious causes of scar were related to SS, but no specific injury type was identified as leading to SS. Although the exact pathomechanism remains unclear, the possibility of systemic involvement could be considered when the patients have multiple lesions, longstanding scars, and elevated serum angiotensin-converting enzyme.

Pandemics (coronavirus disease-2019), experiences, lessons learn, and the future

The coronavirus disease 2019 (COVID-19) pandemic is the defining global health crisis of our time andthe greatest challenge we have faced since World War Two. Since its emergence in Asia in 2019, thevirus has spread everywhere except Antarctica. We have now reached the tragic milestone of more than2 million deaths, and the human family is suffering under an almost intolerable burden of loss. However,the pandemic is much more than a health crisis, it’s also an unprecedented socioeconomic crisis. Stressingevery one in the countries, it has the potential to create devastating social, economic, and political effectsthat will leave deep and long-standing scars. Every day, people are losing jobs and income, with noway of knowing when normality will return. Small island nations, heavily dependent on tourism, haveempty hotels and deserted beaches. We have been supporting countries since the very early stages ofthis crisis, donating essential protective medical equipment. As the response evolves, and after assessingthe immediate, medium- and long-term needs, we are moving into the socioeconomic response. It willrequire all of society to limit the spread of COVID-19 and to cushion the potentially devastating impactit may have vulnerable economies. We must rebuild trust and cooperation, within and among nations, andbetween people and their governments.

COVID-19 Pandemic in Turkey and Kerala, India: Some Observations

There is still lack of clarity regarding the effectiveness of various control measures in containing the COVID-19 pandemic. The experiences from different countries or contexts are diverse. For instance in Kerala state of India, the dispersed settlement patterns could have played an important role as against the nucleated, semi-compact or compact patterns elsewhere in the country including the West. The importance of surveillance, good quality quarantine, testing strategies, uninterrupted treatment services, community participation, proactive care of elderly and people with comorbidity and educational and social mobilisation of behavioural change etc. have also been pointed out as factors which contributed to effective management and control of COVID-19 in Kerala. But such optimism did not last long and the virus had an upper hand despite all these claims. After the one single case on 30 January, it soon hit the peak with super spread and community spread reported in some areas. Turkey is one of the few countries in the world which effectively handled the COVID-19 virus largely due to a scientific approach with rigorous testing. What is observed regarding the number of active cases in Turkey is a peak sometime around the middle of April and then a gradual flattening. The success in Turkey could also be attributed to strict enforcement of Standard protocols. Like many other countries, strict quarantine was also enforced. Turks coming from abroad were quarantined at guest houses for 14 days (for those with no clinical signs), and at designated hospitals in each province (for those with clinical symptoms) till June. Standard protocols such as restrictions on meetings, gatherings and travel were followed. The Country also adopted a fast track mechanism to procure medical supplies, test kits, PPEs, thermal scanners, and other needed diagnostic and curative commodities and distribute it to all possible sites. There is no doubt that the pandemic has already led to devastating social, economic and political effects that will leave deep and longstanding scars. In the longer term, we should look at ways to better prevent and manage such crises and ensure that the world makes full use of what we will learn from this one. This is the reason why there is a need to examine country case studies to understand patterns especially similarities and differences. But an on-going epidemiological assessment based on data is extremely important to strengthen the fight against the pandemic. This is extremely useful for developing an integrated global response as an investment for our future

Marjolin Ulcer: An Observational Epidemiological Study From a Tertiary Care Centre in India.

Marjolin ulcer is a rare skin malignancy. Marjolin ulcer arises in zones of long-standing scars, inflammation, or chronic wounds. The present study was conducted to assess the demographic profile and identify the predictors of recurrence in 55 patients with Marjolin ulcer admitted over 10 years. Patients underwent either wide local excision with 2-cm peripheral margin or amputation if clinically indicated due to joint involvement. Lymph nodes were dissected if found positive. Patients received adjuvant radiotherapy if tumor clearance was less than 4 mm or the draining lymph nodes were positive. Of the total 55 cases (mean age, 48.75 years; range, 24-74 years), 34 were men and 21 were women (male/female, 1.6:1). The most common cause of injury was flame burn (n = 32, 58%) followed by trauma (n = 10, 18%). The lower limb was frequently affected (n = 38, 69.1%). Twenty-six patients with resection margins less than 4 mm had received adjuvant radiotherapy. Among the 55 patients, 6 (11%) had undergone lymph node dissection. Local recurrence was noted within 18 months in 9 (16.35%) patients, of which 5 patients had a tumor-free margin of less than 4 mm. We found 2 predictors for local recurrence. First, moderately differentiated squamous cell carcinoma (P = 0.04) and, second, patients with lymph node involvement (P = 0.001). Marjolin ulcer is a high-risk skin tumor. Patients with positive lymph node or with moderately differentiated squamous cell carcinoma have high chances of recurrence. Frequent and intense follow-up is required for at least 2 years.

Basal cell carcinoma presenting as an excoriated cicatricial plaque: A case report

Abstract Basal cell carcinoma (BCC) is the most common skin cancer with several clinical and histopathological subtypes. Trauma and scar tissue have been implicated as possible etiological causes of BCC. Here, we report a case of a 37-year-old man with BCC arising on a longstanding cicatricial plaque with nearly 30 years' duration. Intractable pruritus, which had started two months ago and gradually intensified, was the patient's main complaint upon admission. The lesion presented as a linear, erythematous, excoriated cicatricial plaque in the left supraclavicular region. Pearly borders and the mildly atrophic center of the plaque, that were recognized upon close examination, were notable features and may indicate BCC. We believe that a detailed patient history and meticulous clinical examination are essential for diagnosing BCC arising in longstanding scars.

Marjolin's ulcer: A rare report.

Sir, Marjolin ulcer is the term commonly used to describe squamous cell carcinoma (SCC) arising on scar tissue. It is a malignant transformation of a chronic ulcer, sinus tract, fistula or long-standing scar of various etiologies. Jame Nicholas Marjolin in 1828 published the classical description of Marjolin's ulcer. The most frequent malignancy that develops in burns scars is squamous in type.[1] Melanoma, schwannoma, sarcoma, trichilemmal carcinoma have also been described.[2] Limbs are the common site for Marjolin's ulcer. Two different clinical presentations are common ulcerative form and less frequent, exophytic papillary form.[3] We report a case of a 58-year-old lady who developed ulcerative and exophytic mass from a 10 year old burns scar over the back She reported with discomfort over the back to the family physician who found and ulcer over the scar and suspected malignancy. Within four months, the ulcer rapidly progressed to a cauliflower-shaped growth. She was not a diabetic or hypertensive. There was no family history of malignancy. On examination, there was a large exophytic ulcerated growth and a small superficial ulcer arising from a large depigmented atrophic scar over the back [Figure 1]. There was no lymphadenopathy. The other skin and mucosal sites appeared normal. Relevant investigations were normal. Histopathology showed a well-differentiated SCC with horn pearls [Figure 2]. She was advised radiation therapy. Figure 1 An exophytic ulcerated growth and a small superficial ulcer with intervening erosion over a large depigmented atrophic scar Figure 2 Histopathology H and E, ×400 showing well-differentiated squamous cell carcinoma with horn pearls The exact pathogenesis of Marjolin's ulcer remains unclear. Theories suggest that cellular mutations as a result of toxins released by damaged, ischaemic and nutritionally deficient tissues are responsible for neoplastic change, with a locally impaired immune function contributing as trigger. Persistence of burns ulcer, induration or elevation of margin of such ulcer, ulceration or nodule formation over a burns scar may indicate malignant transformation. The latent period is shorter in elderly and in cases of basal cell epithelioma. Metastasis among squamous carcinomas following a burns scar is much more common than among those associated with actinic damage.[4] Punch biopsy should be avoided, due to the focal nature of the malignant changes in burn scar.[5] In our case, the spine region being more prone for pressure-induced damage, the resultant necrosis could have initiated the malignant process. This case is reported the rarity of occurrence of Marjolin's ulcer over the back, presenting as both ulcerative and exophytic growth. Even a small abrasion over a long standing burns scar should be viewed with suspicion. All burn scars should be grafted as the incidence of carcinoma is reduced if such wounds are grafted at an early stage.

Unraveling the Longstanding Scars of Early Neurodevelopmental Stress

Early neurodevelopment, both in utero and in the postnatal phase, is a time when stressors can produce long-lasting changes that significantly increase the risk of mental health problems in adulthood (1). Pregnancy complications such as depression in the mother and childhood trauma can impact on neurodevelopment and increase the likelihood of psychiatric illnesses, such as major depression together with anxiety and personality disorders. Large-scale prospective studies indicate that the increased risk of these disorders following early adversity persists into old age. It is equally clear that not everyone who experiences early stressors develops psychiatric illness in adulthood and neither is there a relationship between any specific stress and a particular psychiatric disorder. If we are to ameliorate the impact of early stress, it is important that we gain an increased understanding of the manner in which such stress impacts on biological development and the psychosocial and genetic factors that help decrease the toxic effects of stress. In this regard, two articles in this issue of Biological Psychiatry focus on the underlying persistent neuronal alterations in subjects who have been exposed to, albeit qualitatively different and potent, early-life stressors (2,3). Interestingly, both articles highlight an important role for the amygdala in these effects. Olsavsky et al. (2) provide evidence in a functional magnetic resonance imaging experiment that altered activation of the amygdala plays a role in long-term behavioral problems in maternally deprived children that had been subsequently adopted (children were aged between 6 and 15 years at the time of scanning). Behaviorally, they found that this cohort had indiscriminate friendliness, which can be defined as an uncharacteristic reduced reticence and atypical approach behaviors towards adults, including strangers, being unable to distinguish adopted mothers from strangers and that this was also demonstrable in terms of amygdala discrimination to both types of stimuli. Interestingly, there was a positive correlation between age at adoption and hence duration of maternal deprivation and extent of the amygdala discrimination and behavioral response in terms of indiscriminate friendliness. On the other hand, Rifkin-Graboi et al. (3) takes a different approach, but once again, this study highlights the role of the amygdala in the long-term effects of early-life stress. They show that microstructural changes in the right amygdala (as assessed within the first 2 weeks of life) can be induced as a result of depression in the mother. The study adds further to our understanding of the toxic effect of maternal depression on the developing fetus. It is also worth noting that recent studies are pointing to a link between maternal childhood maltreatment and maternal antenatal depression (4), thus continuing the cycle of stress-induced effects across the generations with the cooccurrence of both insults significantly increasing the risk of offspring adversity. The mechanism for both of these associations is unclear and may include genomic and environmental influences both during fetal development and postnatally. Experimental studies in animals involving gestation stress or in early life are proving invaluable in uncovering key changes in the neurodevelopment of limbic structures, including alteration in amygdala size, neuronal activity, and expression of key stress-related genes (5). Moreover, starting with the work of Levine et al. (6) in Stanford and Meaney et al. (7) in McGill, a growing body of preclinical data in both rodents and nonhuman primates has been focused on understanding the consequences of alterations in maternal care in early life to both the susceptibility and resilience to psychopathology [see (1) for review].

Seven Contemporary Plays: From the Korean Diaspora in the Americas ed. by Esther Kim Lee (review)

Reviewed by: Seven Contemporary Plays: From the Korean Diaspora in the Americas ed. by Esther Kim Lee Heui-Yung Park (bio) Seven Contemporary Plays: From the Korean Diaspora in the Americas, edited by Esther Kim Lee. Durham: Duke University Press, 2012. 360 pages, illustrations. $94.95 cloth, $26.95 paper. Seven Contemporary Plays: From the Korean Diaspora in the Americas anthologizes for the first time plays solely by authors of the Korean diaspora and is thus a significant collection in their literary and composite art history. Editor Esther Kim Lee introduces seven works by providing a brief history of Koreans and the Korean diaspora in the twentieth century and outlining their late development in theater in the United States and Canada. The plays, mostly produced in the 2000s (except Edward Bok Lee's "History K," 1998) by second-generation diasporic writers from North and South America, depart from the often stereotypical success [End Page 155] stories of ethnic model minorities in America but explore various, somewhat under-represented lives of Koreans and their foreign-born or reared children. Lee's "History K" tells a (hi)story of those victimized by the Korean War and the later invasion of U.S. forces through an unidentified, middle-aged prostitute living by a U.S. military base. Her vague nationality and location in the opening become apparent by such clues as the Pagoda Park, where her military night guest found a hat; the Korean name Hyegyung, "found in a tub drown of her own blood" (p. 18); and Hyundai cars running in the street. And the instant flashes of the prostitute's memories take us back to when "I read, a great deal now, more and more [. . .] before the war." The violation of her virgin body by a farmer, which meant "no going back, not after that, no, no going back to that, caught, in the fields, after that no going back, on his farm" (p. 12), points to her victimization as a young woman during the critical period of "History K," whose unsettled modern history has caused long-standing scars in the heart of vulnerable people like her. The Los Angeles-born Julia Joe's "99 Histories" (2004) casts light upon the distant relationship between Korean immigrant parents and their American-born children. Their cultural and generational gap is crystallized by the concept of chŏng, which "doesn't make sense" (p. 42) to the daughter Eunice, who became pregnant by her Caucasian ex-boyfriend and reluctantly returns to her Korean mother, Sah-Jin, after years of absence. If the family's buried secrets, including their breadwinner's premature death at the hands of two customers at his store, have contributed to taking them apart, their ultimate sharing reveals their own pent-up pains and helps bring them together. Concurrently, Eunice comes to better understand chŏng, which includes mother's love and a series of "our" hitherto "Memory plus time" (p. 82). The different sides of the mother and daughter's stories that unfold in "99 Histories" suggest a range of elapsed accounts of the Korean diaspora that need to fill in to overcome their breach. Similarly, Lloyd Suh's "American Hwangap" (2007) brings up issues of a broken diasporic family. Fifteen years ago the immigrant engineer Min Suk Chun, who has just turned sixty, lost his job and went back to Korea, leaving his wife Mary and three children—David, Esther, and Ralph. Although Chun's return to his family in Texas is occasioned by his hwangap, the special sixtieth-birthday ritual that signifies one's longevity and rebirth in Korea, he is not welcomed by David and Esther: David, currently working in New York as an investment banker, does not visit home for the event; Esther comes home only to please Mary but avoids [End Page 156] talking to her father. Yet, that "Chun Min Suk life was not in Korea, was here [America], Mommy here, David, Esther and [. . ..]" (p. 99) reveals his ultimate belonging "here" with them. Chun's marriage proposal to Mary to re-start their life together hints at the possible reunion and rebirth of the Korean diasporic family. The Korean Canadian Jean Yoon's "Hongbu...

Cutaneous sarcoidosis and tribal scarifications in West Africa.

Sarcoidosis is quite common in American and West Indian blacks. In America, the incidence in blacks could be up to 10 times higher than in whites. Sarcoidosis is generally believed to be rarer in African blacks and especially along the West African coast from which the American blacks trace their ancestry. The difference in incidence may be due to environmental influences, poor reporting system from inadequate local awareness of the presentation, confusion with tuberculosis, and lack of the Kveim antigen. Diagnosis of sarcoidosis is most commonly made from the pulmonary and skin manifestations. Since the skin manifestation presents readily for observation without the need for costly devices like x-ray machines, the present study focused on and analyzed the seven cases seen in the skin clinic within a period of 2 years (an incidence of 0.85%), showing that the commonest presentation was as scar-sarcoid on longstanding tribal marks. Tribal scarification is common in West Africa, and one should investigate any change in a longstanding scar. This heightened awareness in areas where scarification is or was practiced could end the belief of the rarity of sarcoidosis in the West African subregion.

Malignant Scalp Tumors in the Young

We report two cases of malignant scalp tumor in young individuals. A 9-year-old girl with recurrent occipital dermatofibrosarcoma protuberans underwent radical resection of the tumor. The extent of the tumor was determined by means of serial frozen sections, and the scalp defect was immediately reconstructed by moving of the skin flaps. In the second case, a 24-year-old male developed squamous cell carcinoma from a long-standing scar in the right retroauricular region. The lesion was radically removed, along with the underlying bone. Descriptions of these two cases and a review of the literature are presented.

Malignant transformation of a scar in the scalp

An unusual case of squamous cell carcinoma arising in a long-standing scar of the scalp is described. There is little literature on this condition. The probable pathogenesis and the treatment are discussed.