Marjolin’s ulcer in chronic wounds – review of available literature

Abstract

Marjolin’s ulcer is a rare, aggressive skin cancer developing in scar tissue, chronic ulcers and areas affected by inflammations. Its incidence is estimated to range from 1% to 2% of all burn scars. It most frequently takes the form of squamous cell carcinoma which sometimes is diagnosed during examination of lesions developing in scars and hard-to-heal chronic wounds (pressure sores, leg ulcers). Therapeutic management of Marjolin’s ulcer requires well-designed treatment plan to ensure optimal medical care and good quality of life for the patient. The high risk of metastases and damage to the structure of vitally important organs determines the need for early diagnosis and prompt surgical intervention with supplementary therapy.The purpose of the study was to examine etiopathogenesis of Marjolin’s ulcer and principles of its treatment. The authors focused on the aspect of malignant degeneration in chronic wounds (leg ulcers, pressure sores) as a very rare, aggressive form of Marjolin’s ulcer. A review of the available literature on the issue of Marjolin ulcers was conducted using the key words; Marjolin ulcers, pressure sore, chronic wound. Malignant degeneration in chronic wounds is a very rare aggressive form of Marjolin ulcer.Increased oncological alertness should be displayed by nursing and medical personnel taking care of patients with chronic wounds.

Malignant Transformation in Diabetic Foot Ulcers—Case Reports and Review of the Literature

“…Hence, malignant cells evade immunological detection and become more aggressive and prone to metastasis [12]. Since no single specific factor has been identified yet, it is likely that pathogenesis is linked with multiple factors of environmental, immunological and genetic nature [13].…”

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

“…Being the second most common form of skin cancer, squamous cell carcinoma (SCC) was mainly caused by cumulative ultraviolet exposure in white populations, while the most predisposing conditions of SCC were scarring processes and chronic inflammation in other populations . This malignant transformation of chronic wounds or scar tissues (mostly post‐burn scars) is known as Marjolin's ulcer (MU), with a reported incidence rate from 0.77% to 2% . Once the malignancy develops, it tends to be more aggressive and is associated with a higher risk of metastasis compared with sun‐induced SCC in Caucasians …”

“…1,2 This malignant transformation of chronic wounds or scar tissues (mostly post-burn scars) is known as Marjolin's ulcer (MU), with a reported incidence rate from 0.77% to 2%. [3][4][5] Once the malignancy develops, it tends to be more aggressive and is associated with a higher risk of metastasis compared with sun-induced SCC in Caucasians. 2,6,7 "Marjolin's ulcer" was first named and published when the French surgeon Jean-Nicholas Marjolin demonstrated the cellular changes of ulcerated lesions in scar tissue in the 19th century.…”

Marjolin's ulcer in a paraplegic man: A further example of the immunocompromised district

“…Marjolin's ulcer is a cutaneous malignancy that arises in previously chronically inflamed skin or scar tissue . It may also develop from pressure ulcers .…”

“…In order to avoid local recurrence, it is necessary to perform wide local excision with a 2–5 cm margin of healthy tissue, with primary or delayed skin graft . Nevertheless, sometimes, the disease's extension does not allow surgery intervention; therefore, radiotherapy as well as chemotherapy may be useful in order to reduce the tumour size or to improve quality of life in patients with short life expectancy …”