Characteristics and prognosis of skin cancer arising from burn scars: a systematic review

Abstract

BACKGROUND: Burn scars are recognized risk factors for malignant skin transformation, most notably Marjolin's ulcer (MU). Despite extensive documentation in case reports and series, the epidemiological characteristics and prognosis of burn scar-related skin cancers have lacked large-scale systematic synthesis. METHODS: We conducted a systematic review in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, registered with PROSPERO (CRD42024545404), covering literature from PubMed, Scopus, and Web of Science up to 18 January 2024. Eligible studies included case reports, case series, and observational studies reporting any type of skin cancer in burn scars. Data were extracted on demographics, burn and tumor characteristics, treatment, latency, outcomes, and risk of bias using Joanna Briggs Institute tools. RESULTS: A total of 211 studies reporting 830 cases were included. The mean latency period from burn injury to cancer diagnosis was 21.7 years (SD = 19.6). Males constituted 53% of patients, with third-degree burns predominating (89.37%) and lower limbs being the most affected site (33.59%). Squamous cell carcinoma (SCC) was the most frequent malignancy (67.19%), followed by basal cell carcinoma (BCC, 3.83%) and other cancers (15.33%). Recurrence occurred in 13.2% of cases; mortality was 6.96%. SCC accounted for most deaths (63.8%), while melanoma and sarcoma exhibited high rates of recurrence and mortality. Lymph node metastasis and distant metastasis were found in 7.56 and 4.74% of cases, respectively. CONCLUSION: Skin cancers arising from burn scars, especially SCC, demonstrate aggressive clinical behavior with significant morbidity and mortality. Reduced latency periods and high metastatic potential highlight the importance of vigilant, long-term surveillance and radical initial treatment. This review provides a contemporary benchmark for epidemiological understanding and supports calls for international registries, molecular diagnostics, and standardized management protocols for burn scar malignancies.