Spindle Cell Squamous Cell Carcinoma Arising in a Chronic Burn Scar: A Case Report and Literature Review of Diagnostic Pitfalls and Oncologic Management Considerations

ABSTRACT: Cutaneous spindle cell squamous cell carcinoma (SpSCC) is a rare variant of cutaneous squamous cell carcinoma that can clinically mimic scar change and histologically overlap with other cutaneous spindle cell neoplasms. We report a 60-year-old woman with a nonhealing ulcerated lesion arising within a longstanding childhood abdominal burn scar. Histopathology demonstrated a mitotically active dermal spindle cell tumor with pancytokeratin positivity and patchy cytokeratin 5/6 expression. This rare case highlights that spindle cell squamous cell carcinoma can arise as a late malignant transformation within longstanding burn scars decades after the initial injury. We also review key histopathologic/immunohistochemical diagnostic pitfalls and summarize practical oncologic and surgical management considerations for treating cutaneous spindle cell squamous cell carcinoma in burn scars as a high-risk cutaneous squamous cell carcinoma.