Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a non-healing, chronic ulceration within a long-standing burn scar. History of thermal injury [Number] years ago. Recent clinical changes include progressive lesion enlargement, increased friability, spontaneous bleeding, and malodorous discharge. Denies recent trauma to the site. Reports localized pain, pruritus, and induration of the scar periphery.
Clinical Examination Findings
Physical examination reveals an exophytic, fungating, or ulcerative lesion located within a mature, hypertrophic, or atrophic burn scar. Borders are irregular, raised, and indurated. Base exhibits necrotic slough or granulation tissue with contact bleeding. Surrounding skin shows signs of chronic inflammation, telangiectasia, and loss of skin appendages. Regional lymphadenopathy assessed; no palpable nodes noted in the [Region] basin.
Treatment Protocol
Plan: 1. Incisional or excisional biopsy for histopathological confirmation (SCC suspected). 2. Surgical wide local excision with [Number] cm margins. 3. Frozen section analysis to ensure clear margins. 4. Reconstruction via split-thickness skin graft (STSG), full-thickness skin graft (FTSG), or local/free flap coverage. 5. Sentinel lymph node biopsy or regional lymph node dissection if clinically indicated. 6. Multidisciplinary oncology consultation.