Does every black necrotic lesion need surgical debridement?

Dermatology; Haematology; Paediatric Surgery
Case Report
10.1102/1470-5206.2011.0017
11
66-69
Does every black necrotic lesion need surgical debridement?

A 4-year-old boy with beta-thalassemia major who underwent a successful bone marrow transplant (BMT), presented with a necrotic looking scalp lesion. Debridement was initially suggested but a punch biopsy showed Aspergillus fumigatus. Antifungal therapy was commenced and the lesion healed with minimal scarring. Invasive fungal infections are a major cause of morbidity and mortality in immune-compromised patients. Invasive aspergillosis (IA) has been on the increase since 1980. The most common manifestation of IA after BMT is invasive pulmonary aspergillosis. Primary cutaneous aspergillosis is extremely rare in the paediatric BMT population. There is scanty information regarding management of these lesions in children. Excision and skin grafting of these lesions is not the ideal treatment in the immune compromised and healing by secondary intention may leave a large scar. Suspicious skin lesions should not be subjected to immediate wide surgical debridement leaving a large uncovered area with subsequent extensive scarring and failure to respond to skin grafting.

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Editor-in-Chief

Frank Cross
Consultant Vascular and General Surgeon
The London Clinic, UK

Editors

Neil Barnes
Consultant Physician
Barts Health NHS Trust, London, UK
Ali Jawad
Professor of Rheumatology
Barts Health NHS Trust, London, UK

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