Clinicopathological evaluation of Marjolin ulcers over two decades

Abstract

Malignant changes arising on the previously traumatized or chronically inflamed skin are defined as Marjolin ulcers. They can develop on many different lesions but frequently they are detected on burn scars. Histopathologically, Marjolin ulcers are mostly diagnosed as squamous cell carcinoma and they need special attention when especially located on the lower extremities. In this study, 63 patients treated for Marjolin ulcers between January 2000 and March 2015 were evaluated according to etiology, histological differentiation, primary tumor size, patient age and anatomical localization. Medical records of these patients were reviewed retrospectively. Mean age was 49.7 years. Average interval between the first injury and carcinoma development was 37.9 years. Most frequent etiologic factor was burn scars with 82.5%. Foot was the most frequently affected site with 28.6% and scalp was the second most frequent localization with 25.4%. Squamous cell carcinomas were detected in 88.9% of the patients and basal cell carcinomas were detected in 11.1% of the patients. For treatment, excision and grafting was performed for 48 patients (76.2%), excision and local flaps were used for 10 patients (15.9%) and excision and free flaps were used for five patients (7.9%). Regional lymph node dissection was performed for 12 patients (19%). Average follow up period was 46.5 months. Local recurrences were detected in nine patients (14.3%). In conclusion, Marjolin ulcers are aggressive tumors that require special care. In order to prevent life threatening sequelas of this entity, it is important to know basic aspects of clinical progress, prognostic factors and treatment modalities.

Marjolin’s Ulcer: Experience from a Developing Country

“…As like other studies, the most common site of MU in our study was lower limb. The second most common site in our study was upper limb which is in contradiction to other studies in which head and neck is the most common site after lower limb [9][10][11]. In our study regional lymphadenopathy was found in 16% cases by combining clinical examination with routine USG evaluation of regional LN basin.…”

“…Although we did therapeutic LN dissection in 15 cases for cases which had LN metastasis confirmed on preoperative evaluation, none of our patients underwent any form of prophylactic LN surgery and none had any recurrence in regional LNs during the follow up. Recurrences are not uncommon and an incidence of 14-33% been reported in literature [11,14]. 19.1% patients in our study developed local recurrence.…”

“…In fact the LN metastasis reported in literature varies widely, with some studies have reported LN metastasis in more than 60% cases [10]. Most common histological type in most series including ours is SCC which accounted for 90.4% cases in our series which is a bit higher than most series where it constitutes about 70-90% of the ulcers [9,11]. Intraoperative frozen section analysis of the resected margins has been suggested as an useful tool to know the status of the resected margins and guide the surgeon in further management [12].…”

Early Transformed Diabetic Foot Ulcer into a Malignancy: A Case Report

“…2,5) Marjolin's ulcer most commonly refers to a squamous cell carcinoma, 3) and burns are considered the most common cause of this condition. 1,2) A case of Marjolin's ulcer in a patient with a diabetic foot has been reported, but it occurred 60 years after a scar was formed.…”

“…The average latent period of the chronic type was reported about more than 30 years. 2,5) Here, we present a case of Marjolin's ulcer that developed from early stage untreated diabetic foot ulcer.…”