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European Journal of Applied Sciences – Vol. 12, No. 2

Publication Date: April 25, 2024

DOI:10.14738/aivp.122.16708

Gaviria-Castellanos, J. L., Fayad-Lemaître, F., & Duque-Bocanegra, M. L. (2024). Full Thickness Burn Associated with Cutaneous

Lymphoma Managed with Acellular Dermal Matrix: Case Report and Literature Review. European Journal of Applied Sciences, Vol

- 12(2). 186-196.

Services for Science and Education – United Kingdom

Full Thickness Burn Associated with Cutaneous Lymphoma

Managed with Acellular Dermal Matrix: Case Report and

Literature Review

Jorge Luis Gaviria-Castellanos

Hospital Simón Bolívar. Bogotá, Colombia

and Universidad del Sinú. Bogotá, Colombia

Federico Fayad-Lemaître

ORCID: 0000-0002-2558-8942

Universidad del Sinú. Cartagena, Colombia

Martha Liliana Duque-Bocanegra

El Bosque University. Bogotá, Colombia

ABSTRACT

Objective: To perform a literature review of patients that presented burns

associated with previous malignant skin neoplasms, and to report the clinical case

of a patient with a diagnosis of 2 types of cutaneous T lymphoma who also presented

a chemical burn. Likewise, to evaluate the postoperative functional and aesthetic

results after the reconstruction of the injured tissue with a monolayer acellular

dermal matrix (Integra®) and partial skin grafts, in the same surgical time.

Methods: A descriptive observational study of a case report type and narrative

literature review was carried out. The case report is presented thoroughly and the

literature review was made in databases with a combination of MeSh terms. Results:

No reports of cases of burns associated with cutaneous lymphoma were found in the

literature. The proposed surgical management was successful, in which the dermal

matrix and skin grafts integrated completely, an aesthetic and functional outcome

was achieved, and no functional limitations of the limb were evident during the

postoperative period. Conclusions: The treatment of burns in patients who

previously have a malignant cutaneous disorder is aimed at surgical debridement

and reconstruction of the skin coverage with partial skin grafts, as soon as possible.

The use of a dermal matrix reduces the possibility of scar complications. As far as

we could verify, this is the first time that a burn has been reported on skin

previously affected with two lymphoma-type skin neoplasms managed with a

dermal matrix, concluding that the neoplasm does not affect dermal matrix

integration.

Keywords: Cutaneous T cell lymphoma, mycosis fungoides, acellular dermal matrix, skin

autografts, burns.

INTRODUCTION

Burns are considered injuries that not only alter the skin locally, but also cause a broad systemic

response. One of these is the immune response, which is activated once the skin coverage is

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Gaviria-Castellanos, J. L., Fayad-Lemaître, F., & Duque-Bocanegra, M. L. (2024). Full Thickness Burn Associated with Cutaneous Lymphoma Managed

with Acellular Dermal Matrix: Case Report and Literature Review. European Journal of Applied Sciences, Vol - 12(2). 186-196.

URL: http://dx.doi.org/10.14738/aivp.122.16708

breached in order to protect the organism from the environment and the colonization and

proliferation of microorganisms. In severe burns, this defense mechanism can compromise the

patient's immunity and induce a systemic inflammatory response syndrome that is difficult to

manage, tissue infection, sepsis and death. This immunosuppression is greater when the burns

occur on skin previously affected by a skin disorder, further increasing the possibility of

infections and making the reconstruction of the injured tissue difficult due to the impairment

of the healing and integration processes of partial skin grafts, as occurs in neoplasms of the

immune system such as the cutaneous lymphoma [1].

Cutaneous T-cell lymphomas (CTCL) constitute 75-80% of all skin lymphomas and Mycosis

Fungoides (MF) is the most common type and represents 60% of CTCL, followed by primary

cutaneous anaplastic large cell lymphoma (PC-ALCL), which represents 25% of all primary

cutaneous lymphomas. Each of them shows different proportions of neoplastic cells, clinical

presentation, treatment and prognosis [2, 3]. T-cell lymphoma is clinically characterized by

presenting circular and oval plaques or spots, well-defined, hyperemic, scaly, pruritic, of

different sizes and slightly raised. They occur more frequently in areas not exposed to the sun

such as the trunk and extremities. The lesion evolves and progresses slowly and is sometimes

associated with the presence of bumps or nodules on the skin that fissure, ulcerate and can

become infected. A thickening of the skin frequently occurs, which is most evident on the palms

of the hands and soles of the feet, causing cracking in this area [3]. Its etiology is unknown and

alterations and mutations occur in the DNA of T lymphocytes, altering the immune system,

affecting the skin and lymph nodes. Skin lesions may be accompanied by fever, night sweats

and weight loss. Its diagnosis is confirmed by skin biopsy, peripheral blood smear, and flow

cytometry for circulating malignant T cells. It occurs more frequently in men over 50 years of

age. Treatment targets the skin using topical chemotherapy, phototherapy, radiation therapy,

and retinoids. In patients with Sézary syndrome, a variant of CTCL, therapy can be systemic. MF

can seriously affect the skin, lymph nodes, bone marrow and cause the death of the patient [4,

5].

The objective of the present study was to report the results of a literature review made on burns

associated with malignant cutaneous dermatoses, and to evaluate the surgical treatment with

acellular dermal matrix and its evolution in a patient with CTCL.

MATERIALS AND METHODS

A literature review of articles published from January 2015 to June 2023 was carried out using

the following databases: PubMed, Google Scholar, Scopus, ScienceDirect and ClinicalKey. MeSH

search terms included “Burns, Cutaneous T-Cell Lymphoma, CD30+ Anaplastic Large-Cell

Lymphoma, Primary Cutaneous CD30-positive Large T-Cell Lymphoma, Mycosis Fungoides,

Acellular Dermis, Graft,” which were combined in different ways with the “AND” connector. As

inclusion criteria, all case reports, series and cohort studies written in English and Spanish were

taken into account, which described cases of acute burns associated with some malignant

cutaneous skin disorder or with some type of cutaneous lymphoma. Repeated articles and all

publications on cutaneous lymphomas or malignant cutaneous skin disorders that were not

associated with acute burns were excluded. The search returned 470 articles. Of these, only 24

presented some of the search terms in the title or abstract. After reviewing all the abstracts, no

article was found that met all the inclusion criteria established by the authors: cutaneous