Marjolin's Ulcer - Case Report and Literature Review

Abstract

We report squamous cell carcinoma (SCC) arising within a burn scar. The eponym "Marjolin's ulcer" was derived from a French surgeon Jean Nicholas Marjolin, who observed and classified cellular changes in burned skin and coined the term "ulcere cancroide". We review literature and current diagnostic modalities and treatment of this not so uncommon disease. The pathophysiology of Marjolin's ulcer is unclear. Two per cent of skin malignancies are estimated to arise within burn scars. According to concurrent epidemiological analyses, squamous cell carcinoma is the most frequent malignancy to arise within burned/chronically wounded skin (75-96%), followed by basal cell carcinoma (12%), melanoma (3%), sarcoma (isolated cases). If Marjolin's ulcer diagnosis is established, wide local excision (at least 2 cm lateral margins) comprising fascia should be performed. The wound could be closed with transposed cutaneo-subcutaneous flap or with free flap. Long term treatment outcome is relatively good, but strict and prolonged follow-up is mandatory.

Acute Marjolin’s Ulcer in a Postauricular Scar after Mastoidectomy

“…In 1828, Jean Nicholas Marjolin, a French surgeon, described a phenomenon that involved the formation of ulcerations within a burn scar and coined the term “ulcere cancroide”; however, the description did not say that the ulcers were malignant [13]. In 1838, Dupuytren observed that de novo malignancy could arise in chronic wounds; he observed this phenomenon in a Belgian man who was treated for a cancer that developed from a scar sustained from a sulphuric acid burn [14].…”

Recurrent Marjolin’s Ulcer With Regional Lymph Node Metastasis

“…(4) The skin lesion underlying development is predominantly burn scar (75%), traumatic non healing wound (8%), venous stasis ulcer (6%), pressure ulcer (3%) and other e.g. Frost bite, vaccination scar .…”

“…(2) Most commonly it is located on lower extremities (53%), upper extremities (18%), trunk (12%), face and nape (5%), scalp (9%). (4) Aetiology of Marjolin's ulcer is not yet clear. Many hypotheses have been suggested.…”

“…(12) Tumours which have latent period of >5 years, situated over trunk and lower limb, infiltrative form, poorly differentiated and presence of regional lymph node metastasis have worse prognosis. (4) Stage and grade of the tumor, presence of metastases and presence of local recurrence are the main predictors of death. (13) CONCLUSION: Marjolin's ulcer should be considered as a significant post-burn complication; (5) it should be treated with full emphasis on adequate local clearance and regular follow up for many years; if not treated adequately, it may lead to complicated recurrence.…”