Patient Overview

A 52-year-old male patient presented with a complex medical history of a burn injury sustained at the age of 5, affecting his upper body and right arm. Over the years, the injury had only partially healed, leading to repeated wound breakdown, chronic ulceration, and restricted movement of the right shoulder.

Symptoms and Progression

For more than four decades, the patient managed recurring skin issues. However, over the last 1.5 years, he developed a large, non-healing ulcer in the right axilla (underarm region, which gradually increased in size. This was accompanied by tingling and numbness in the right upper limb, significantly affecting his daily activities.

Diagnosis

The patient visited the Outpatient Department (OPD), where detailed investigations were conducted, including:

MRI of the right upper limb and axilla
PET scan

A biopsy confirmed well-differentiated squamous cell carcinoma in the right axilla with lymph node metastasis.

Treatment Planning and Surgical Intervention

Given the tumor’s proximity to major blood vessels and nerves of the right upper limb, along with associated infection and involvement of surrounding muscles, the case required meticulous planning.

The surgical team performed:

Wide excision of the tumor along with affected skin and soft tissue
Preservation of critical nerves and blood vessels
Reconstruction using a pedicled latissimus dorsi flap
Split-thickness skin graft to cover the defect

The surgery lasted approximately 7 hours and was successfully completed on 20th January 2026.

Challenges Faced

This case was particularly challenging due to:

Tumor location near vital nerves and blood vessels
Infection in the ulcerated wound
Distorted anatomy from previous burn injury
Involvement of surrounding muscles and soft tissue

Despite these complexities, the surgical team ensured complete tumor removal while preserving limb function.

Recovery and Outcome

Post-surgery, the patient had a smooth recovery:

Hospital stay: 10 days
Successful wound healing and graft acceptance
Sutures removed during follow-up

At one-year follow-up, the patient has resumed his profession as a tailor and reports satisfaction with both functional and cosmetic outcomes.

What Makes This Case Unique

This case highlights the rare but serious risk of long-standing burn scars developing into skin cancer. The presence of infection, altered anatomy, and proximity to vital structures made the surgery highly complex.

Through advanced surgical expertise and careful reconstruction, the team achieved:

Complete cancer removal
Preservation of limb function
Successful wound healing

Key Takeaway

Chronic, non-healing wounds especially those arising from old burn injuries should never be ignored. Early evaluation and timely intervention can prevent serious complications, including cancer.