Majolin's ulcer is a carcinomatous ulcer from degenerating burn scars. This patient is a 44 year-old man who has been suffering from pain and itching sensation on Rt. wrist of burn scars. Symptom has been developed since 18 months ago. Skin lesion is a well defined, slight brownish colored, scaly verrucous surfared plaque with reddish ringlike border and oozing tendency in small part. On physical examination, he is in within normal limit excepet burn scar on Rt. upper extremity. He was received burn with gasolin at the age of seven. Biopsy on the skin lesion revealed well differentiated squamous cell carcinoma appearance. Diagnosis was confirmed by the history and histopathological finding. Literature was briefly reviewed.
Adult ; Biopsy ; Burns ; Carcinoma, Squamous Cell ; Cicatrix ; Diagnosis ; Humans ; Physical Examination ; Pruritus ; Sensation ; Skin ; Ulcer* ; Upper Extremity ; Wrist

BACKGROUND: Advanced hepatocellular carcinoma (HCC) with portal vein thrombosis has a poor prognosis and has little hope for meaningful therapy. Transarterial chemoembolization has been performed as a treatment for advanced HCC, but some patients die from progressive liver failure after therapy. This study was undertaken to evaluate the therapeutic effects of intra-arterial infusion chemotherapy in advanced HCC with portal vein thrombosis, and to compare with those of systemic chemotherapy, and to identify prognostic factors that could affect survival. METHODS: Between January 1995 and January 2001, a total of 102 patients with advanced HCC having portal vein thrombosis (TNM stage IVa) were enrolled and divided into 3 groups; Group 1 (n=24) was managed with only conservative treatment, group 2 (n=25) received systemic combination chemotherapy consisting of 5-fluorouracil (FU) + Adriamycin + Mitomycin C, or 5-FU + Etoposide + Cisplatin, and group 3 (n=52) received intra-arterial infusion chemotherapy with 5-FU (250 mg for 5 days) + cisplatin (10 mg for 5 days) via implanted chemoport. RESULTS: One-year survival rates were 0%, 4%, 21%, and median survivals were 2-, 4-, 6 months in group 1, group 2, group 3, respectively (p=0.003). When we divide group 3 patients into long term survivors (more than 8 months) or short term survivors (less than 8 months), former had significantly lower level of serum AST (p=0.032) and alkaline phosphatase (p=0.033). Especially, all female patients (n=9) survived more than 8 months, and had a longer survival than male patients (p=0.000). Other favorable prognostic factors for survival were cirrhosis of Child-Pugh class A (p=0.003), only one major branch involvement of the portal vein by tumor (p=0.005), presence of enhancement of tumor portion in arterial phase of CT scan (p=0.044), presence of enhancement of non-tumor portion in portal phase of CT scan (p=0.029). CONCLUSION: Intra-arterial infusion chemotherapy achieved favorable results in advanced HCC with portal vein thrombosis and showed better survival in selected patients. This therapy can be tried as a treatment option for the management of advanced HCC.
Alkaline Phosphatase ; Carcinoma, Hepatocellular* ; Cisplatin ; Doxorubicin ; Drug Therapy* ; Drug Therapy, Combination ; Etoposide ; Female ; Fibrosis ; Fluorouracil ; Hope ; Humans ; Infusions, Intra-Arterial* ; Liver Failure ; Male ; Mitomycin ; Portal Vein* ; Prognosis ; Survival Rate ; Survivors ; Thrombosis ; Tomography, X-Ray Computed ; Venous Thrombosis*