It is well known that chronic burn scars are one of the causative factors in malignant transformation. These tumors almost always occures squamous cell carcinomas (SCC), however, other types of malignancies including sarcomas, although rare, have been reported. From January 1992 to December 2001, we diagnosed and treated 11 cases of malignancies arising in chronic burn scar (six females and five males). The patients ranged in age from 44 to 90 years old. Follow up period ranged from 12 months to ten years. Histological diagnosis was SCC in seven cases, malignant proliferating trichilemmal cyst in two cases, basal cell carcinoma in one case and dermatofibrosarcoma protuberans in one case. Location of the tumor was the extremities in eight cases, head in two cases, and face in one case. Interval from initial burn injury to diagnosis of malignant tumor ranged from 15 to 62 years. At the time of diagnosis, regional lymph node metastasis was found in one case of SCC, however, all patients were free of signs of distant metastasis. The lesions were excised widely to include the surrounding burn scar. Amputation was required in two cases. In the other nine cases, the tumors were excised and the defects were covered with skin graft in five cases, myocutaneous flap and skin graft in three cases, and local skin flap in one case. Regional lymph-node dissection was performed in five cases of SCC, including the case with lymph node metastasis. Adjuvant chemotherapy was performed in five cases after the operation. There were no signs of lymph node and distant metastasis or local recurrence during the follow up period in ten cases, however in one case, distant metastasis occurred and the patient died due to tumor one year after the operation. Our experience shows that we should recognize that various kinds of malignant tumors can develop in chronic burn scar, and that there are no standardized treatment methods for burn scar malignancies. Such variation in burn scar malignancies could be caused by variation in the surgical and postoperative adjuvant therapies. Therefore, a careful therapeutic plan should be established based on the histological diagnosis.

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