Pseudoepitheliomatous Hyperplasia Mimicking Marjolin's Ulcer in a Post-Acid Burn Scar Contracture: A Case Report
This case report describes a 52-year-old man with a 42-year-old acid burn scar who presented with a lesion clinically resembling Marjolin's ulcer but was ultimately diagnosed with benign pseudoepitheliomatous hyperplasia following histopathological examination.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Imagine a scar that has sat on the skin for decades, a silent map of an old injury that has long since healed. For most people, such a mark is a memory, a static piece of history. But in the world of medicine, these old scars can sometimes hide a dangerous secret. When a long-standing scar suddenly changes—growing a new sore, swelling, or developing a rough, cauliflower-like lump—doctors must act quickly. The primary fear is a specific type of cancer known as Marjolin's ulcer. This is a serious condition where skin cancer, usually squamous cell carcinoma, grows out of chronic wounds or old burn scars. It is a deceptive enemy because it often looks exactly like a benign, non-cancerous reaction to irritation, making it incredibly difficult to tell the two apart without looking at the tissue under a microscope. The stakes are high: treating a harmless lump as cancer leads to unnecessary, aggressive surgery, while missing a real cancer allows it to spread.
In a recent case report, a team of surgeons in Bangladesh encountered a patient who presented with all the classic warning signs of this dangerous transformation. The man was fifty-two years old and had lived with a severe acid burn on his right thigh since he was a child. Forty-two years after the original injury, a small area of his scar, which had already caused his skin to tighten and restrict his movement, began to change. Following a minor bump to the area, a sore appeared. Over two months, it grew into a large, painless ulcer with raised, everted edges that looked like a cauliflower. The lump was firm to the touch, and the man also had swollen, firm lumps in his groin, which are the lymph nodes that drain that part of the body. To the examining doctors, every clue pointed toward Marjolin's ulcer. The long time since the injury, the sudden growth after trauma, the specific shape of the sore, and the swollen nodes were the textbook indicators of malignancy.
Because the clinical picture was so convincing, the medical team did not wait. They decided to remove the entire suspicious area to ensure the patient's safety. Under spinal anesthesia, the surgeons performed a wide local excision, cutting out the ulcer and a generous margin of healthy skin around it to ensure no hidden cancer cells were left behind. They also removed the swollen lymph nodes from the groin to check if the disease had spread. The wound was then covered with a skin graft taken from another part of the patient's body. The removed tissue and nodes were sent to a pathologist, a specialist who examines cells under a microscope to determine exactly what the growth was.
The results of the microscopic examination revealed a surprising twist. Despite the alarming appearance and the swollen lymph nodes, the tissue did not contain cancer. Instead, the pathologist found a condition called pseudoepitheliomatous hyperplasia. This is a benign, or non-cancerous, overgrowth of skin cells. It happens when the skin reacts to chronic irritation or injury by growing rapidly and deeply, mimicking the look of cancer so closely that even experienced doctors can be fooled. The cells were growing in a chaotic, irregular pattern that looked like an invasive tumor, but they were not malignant. Furthermore, the swollen lymph nodes in the groin were not filled with cancer cells; they were simply reacting to the long-standing inflammation of the ulcer, a common response known as reactive lymphadenopathy.
This case highlights a critical lesson in medical diagnosis: what a lesion looks like on the surface is not always what it is underneath. The patient had every reason to be suspected of having cancer, yet the final diagnosis was a benign condition that required no chemotherapy or radiation. The surgery itself served as the cure, removing the overgrowth and releasing the tight scar contracture that had limited his movement for years. The patient recovered well, with the new skin graft taking hold successfully. The story of this patient serves as a reminder that while doctors must always treat suspicious scars with extreme caution and assume the worst until proven otherwise, the final answer always lies in the careful examination of the tissue. Sometimes, the most terrifying-looking growth is just a dramatic, but harmless, reaction of the body trying to heal.
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