507 The Acute Development of Donor Site Squamous Cell Carcinoma: A Case Report and Review of the Literature

S A Miotke; W J Mohr

doi:10.1093/jbcr/irz013.399

Abstract Introduction The mainstay of burn reconstruction remains autografting. Donor site management centers on pain control, infection prevention, and scarring mitigation. Here we report a rare case of rapidly developing squamous cell carcinoma (SCC) at a split-thickness skin graft donor site. Methods A 49-year-old man with no significant medical history sustained a 5% total body surface area (TBSA) full-thickness burn to the right upper arm, axilla, and trunk when his shirt sleeve caught fire at work. He underwent tangential excision and split-thickness skin grafting with VAC placement on post-burn day two. His right thigh donor site was dressed with an iodine-impregnated adhesive dressing. Graft loss necessitated return to the operating room on post-operative day 17 for re-excision and split-thickness skin grafting, again harvested from the right thigh. The donor site was dressed with a collagen-bound silicone dressing. On post-operative day 58/41 a lesion was noted on his right thigh donor site, presumed to be a cyst. On post-operative day 86/69, the lesion had grown to 7 millimeters. Excisional biopsy on post-operative day 129/112 revealed the lesion to be a well-differentiated squamous cell carcinoma with positive deep and peripheral margins. The patient returned for excision to negative margins 24 days later. Results Since 1948, seventeen prior cases of split-thickness skin graft donor site lesions have been reported in the literature. Fourteen of these (82%) were squamous cell carcinomas, with the remainder diagnosed as keratoacanthomas (KA) - a spontaneously regressing form of SCC, which rarely becomes invasive. Of the fourteen cases of SCC, thirteen (93%) were diagnosed within one year of graft harvest, and eleven (79%) were diagnosed within 6 months. Including our case, five of the cases involved burn patients. Conclusions The acute development of SCC at skin graft donor sites is a rare but serious phenomenon. Marjolin’s ulcers - the development of malignancies, commonly SCC, within chronic wounds - typically develop decades after injury. Trauma, including skin graft harvest, has been associated with the development of KAs, but, is not a typical risk factor for SCC. Given the diversity of autograft indications in reviewed literature, it seems unlikely that the burn itself contributed to the development of SCC. Rather, suspected contributing factors include an increased population of dividing cells provided by re-epithelialization in combination with decreased immune surveillance provided by the lack of lymphatic regeneration. Applicability of Research to Practice The rapid development of squamous cell carcinoma at a skin graft donor site represents a rare but serious possibility. Donor site diligence must be maintained post-operatively.

507 The Acute Development of Donor Site Squamous Cell Carcinoma: A Case Report and Review of the Literature

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