A review of 31 cases of Marjolin's ulcer on scalp: Is it necessary to preventively remove the scar?

Abstract

We aimed to report the clinical features of squamous cell carcinoma (SCC) occurring on scalp scar tissue among a Chinese population, demonstrate its pathological progress, analyse the prognosis‐related factors, and share our clinical experience of managing this rare disease in practice. A retrospective study was conducted at West China Hospital from January 2013 to January 2018 aiming to identify patients with a diagnosis of SCC or squamous atypical hyperplasia arising from scalp scars. Their medical records were reviewed, and related data were retrieved. Follow up was conducted, and informed consent was obtained by phone calls in June 2018. Of the 31 scalp Marjolin's ulcer (MU) patients, the average latency period and post‐ulceration period were 42.9 years and 37.5 months, respectively. Among them, 30 patients (97%) were diagnosed with cancer more than 5 years after initial injury, and 25 patients (80.7%) experienced a pre‐ulceration period longer than 20 years. A negative correlation between scalp MU's post‐ulceration period and its pre‐ulceration period was identified. Only burn scars caused post‐ulceration periods of more than 24 months (7/19). Incomplete healing wounds experienced a significantly shorter latency period (P = 0.004) and longer post‐ulceration period than others (P < 0.0001). However, the depth of tumour infiltration and complete tumour resection were the only two independent factors that significantly dictated patients' survival in this study. In conclusion, the scalp scaring tissue experienced a long‐term stable period but would transform to malignancy rapidly and progressively once ulceration formed. The underlying malignant transformation mechanism remains unclear. Thus, we recommend scalp scarring tissue to be radically removed.

Extensive Marjolin’s Ulcer of Scalp in a Patient with Cardiac Dysfunction - A Reconstructive Challenge

“…Metastasis in this disease has also been documented and once it does, prognosis worsens [7,9,11]. The most common age of affection of this malignancy is 53 to 59 years and the lag period ranges from 4 weeks to 70 years with a mean of 36 years [7,8,9]. In case of our patient the lag period was 16 years and post ulceration period of 36 months.…”

“…Whereas vaccination, snake bites, osteomyelitis, pilonidal abscesses, pressure sores, and venous stasis may also induce this tumour [2][3][4][5][6]. Metastasis in this disease has also been documented and once it does, prognosis worsens [7,9,11]. The most common age of affection of this malignancy is 53 to 59 years and the lag period ranges from 4 weeks to 70 years with a mean of 36 years [7,8,9].…”

Non‐healing wounds: Can it take different diagnosis?

“…In a chronic wound, chronic ulcers may develop a malignant transformation (Marjolin's ulcer). This is a long‐term stable period but would transform to malignancy rapidly and progressively once ulceration formed . The underlying malignant transformation mechanism remains unclear.…”

“…This is a long-term stable period but would transform to malignancy rapidly and progressively once ulceration formed. 10 The underlying malignant transformation mechanism remains unclear. Sometimes, as in our patients, locally advanced tumours may appear as an ulcerated, non-healing chronic wound.…”

Prognostic factors of Marjolin’s ulcers: A Meta-analysis and Systemic Review Assisted with Machine Learning Techniques

“…The details of the included studies are summarized in Supplemental Digital Content 2 and 3. [42][43][44][45][46][47][48][49][50][51][52][53][54] (See Table, Supplemental Digital Content 2, which shows appraisals with the tool for evaluating the methodologic quality of case reports and case series. This tool originally consisted of eight questions.…”