Marjolin's Ulcer Presenting with In-Transit Metastases: A Case Report and Literature Review

Altunay, İlknur Kıvanç; Çerman, Aslı Aksu; Sakiz, Damlanur; Ateş, Bilge

doi:10.5021/ad.2015.27.4.442

Cited by 11 publications

(9 citation statements)

References 18 publications

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“…In non-melanoma cutaneous malignancies, in-transit metastasis and satellitosis are very rare and therefore, the prognostic consequences are unclear. They are not mentioned in AJCC-8 staging system for head and neck nonmelanoma skin cancer [9,10,19]. However, the 5-year survival rate of 13% in the largest series [8] and as these phenomena represent regional metastasis and aggressiveness of the primary disease, adjuvant radiation therapy for locoregional control and chemotherapy for prevention of regional and distant metastasis should be considered.…”

Section: Discussionmentioning

confidence: 99%

“…When a regional metastasis is within 2 cm (an arbitrary cutoff) from the tumor, it is defined as satellitosis, whereas a regional metastasis beyond 2 cm is defined as in-transit metastasis [5][6][7]. The concept and clinical significance of in-transit metastasis and satellitosis have been established for melanoma, but they are very rare in other skin malignancies; overall only 59 in-transit metastases from SCCs have been reported [8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

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A spindle cell squamous cell carcinoma on the cheek presenting with in-transit metastases and a satellite lesion

Lee

2020

Arch Craniofac Surg

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Spindle cell squamous cell carcinoma (SpSCC) is a biphasic tumor composed of squamous cell epithelial and spindle cell mesenchymal components, both of which are malignant. Cutaneous SpSCC can cause diagnostic and therapeutic difficulties because of its rarity, heterogeneity, morphological similarity to other cutaneous spindle cell neoplasms, and uncertain pathogenesis and prognosis, particularly when the squamous cell carcinoma component is minimal or missing. Intransit metastasis and satellite lesion (satellitosis) constitute a spectrum of non-nodal regional metastases. Here the author reports the first known case of cutaneous SpSCC presenting with intransit metastases and a satellite lesion, which were exceptionally aggressive. A 77-year-old female patient presented with a 3 × 3 × 0.5 cm mass on her right cheek. Despite wide excision and postoperative radiation, the patient resulted in local recurrence and multiple distant metastases within 3 months. If many high-risk factors-particularly satellitosis and in-transit metastases are observed in a tumor with epithelial to mesenchymal transition, then further wide excision and adjuvant chemoradiation should be considered early in the treatment process. A multidisciplinary approach could be the key to cure the most aggressive malignancies of the skin, as in other organs.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A spindle cell squamous cell carcinoma on the cheek presenting with in-transit metastases and a satellite lesion

Lee

2020

Arch Craniofac Surg

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“…Furthermore, the trend in recurrence time is another characteristic of Marjolin's ulcer. Various studies have reported that Marjolin's ulcer has a short recurrence time (12–14). However, the present study indicated that the mean recurrence time for Marjolin's ulcers was 21.7±7.2 months, and the recurrence time was significantly longer than that reported in previous studies.…”

Section: Discussionmentioning

confidence: 99%

“…However, due to the lack of large-scale studies, the reported aetiology and clinical characteristics, as well as treatment methods and effects vary considerably (5,10,11). For instance, the recurrence times of Marjolin's ulcers vary between studies; certain studies have reported the mean recurrence time of 4.66±2.07 months, while others have reported recurrence times of 3–10 months with a mean of 5.4 months, and still others have reported recurrence in 6–11 months with a mean of 8.8 months (3,12–14). To further elucidate the features of this pathology, the present study retrospectively analyzed the aetiology, clinical characteristics and therapeutic efficiency in patients with Marjolin's ulcer who were admitted to and treated at the Institute of Burn Research of Southwest Hospital (third Military Medical University, Chongqing, China) between January 2013 and December 2017.…”

Section: Introductionmentioning

confidence: 99%

Clinical features and treatment of 140 cases of Marjolin's ulcer at a major burn center in southwest China

2019

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Marjolin's ulcer is a type of malignant tumor that occurs in scar tissue. The present study aimed to summarize and analyze the aetiology, clinical characteristics, treatment methods, metastasis and prognosis of this disease. A total of 140 cases of Marjolin's ulcer encountered at the Institute of Burn Research, Southwest Hospital (Chongqing, China) between January 2013 and December 2017 were retrospectively analyzed. Demographic data, clinical characteristics, occurrence of bone invasion and lymph node metastasis, as well as treatment and prognosis were statistically analyzed. Among the 140 patients, the initial injury or primary disease occurred at 1–75 years of age, while Marjolin's ulcer occurred at 15–85 years of age (mean, 53.3±1.2 years). The mean latency period was 28.8±1.7 years. The most common initial injury of the patients was flame burns, followed by skin masses, trauma, skin ulcerations caused by repeated scratching/friction, and scalding. The age at onset of initial injury or disease in patients had a significantly negative correlation with the latency period (P<0.01). The most common lesion locations were the lower limbs (42.1%), followed by the head, face and neck (34.5%). Of the 140 patients, 46 cases (32.9%) had bone invasion, 33 cases (23.6%) had lymph node enlargement and only 5 cases (3.6%) had lymph node metastasis. The skull was the bone that was most susceptible to Marjolin's ulcer invasion. The prevalence of bone invasion in patients with head, face and neck lesions was significantly higher than that in patients with lesions in other locations (P<0.01). The surgical methods applied were skin grafting, local flap repair, amputation and island flap repair. In the 65 cases who underwent follow-up, recurrence mainly occurred within 1 year after surgery. In conclusion, Marjolin's ulcer mainly occurred in males and was a scar carcinoma after a flame burn in most cases. Autologous skin grafting and local skin flap repair were the major repair methods. The peak period of recurrence was within one year after surgery and patients should receive regular follow-ups.

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“…Compared to Caucasians, SCC in the African American population is uncommon, with females being affected more than males, and lower extremity being the most common site (12,13). The incidence of SCC in chronic ulcers has been reported to be approximately 1% in a small retrospective study (14). The duration of ulcer formation might be a contributing factor in the development of SCC.…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Hypercalcemic Crisis Secondary to a Squamous Cell Carcinoma Arising from a Nonhealing Ulcer

Saeed

George

Lajara

et al. 2017

AACE Clinical Case Reports

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Objective: To report a case of hypercalcemic crisis in an African American male who presented with a nonhealing ulcer which was later found to be squamous cell carcinoma.Methods: All relevant data, radiologic imaging, and pathology reports were reviewed in detail. An in-depth literature review for humoral hypercalcemia of malignancy and cutaneous squamous cell carcinoma was performed using MEDLINE.Results: A 58-year-old man with a history of chronic lymphedema presented with fever and a nonhealing left foot ulcer. Initial studies revealed acute kidney injury, anemia, and non-parathyroid hormone (PTH)-mediated hypercalcemic crisis (calcium, 17.7 mg/dL). A thorough work-up ruled out bone metastasis and confirmed increased PTH-related peptide, which is the hallmark of humoral hypercalcemia of malignancy (HHM). Hypercalcemia was initially managed with intravenous fluid hydration, bisphosphonates, and calcitonin. The patient had surgical resection of the left leg, and pathology revealed cutaneous squamous cell carcinoma. Hypercalcemia resolved completely after surgical resection of the tumor.

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Marjolin's Ulcer Presenting with In-Transit Metastases: A Case Report and Literature Review

Cited by 11 publications

References 18 publications

A spindle cell squamous cell carcinoma on the cheek presenting with in-transit metastases and a satellite lesion

A spindle cell squamous cell carcinoma on the cheek presenting with in-transit metastases and a satellite lesion

Clinical features and treatment of 140 cases of Marjolin's ulcer at a major burn center in southwest China

A Rare Case of Hypercalcemic Crisis Secondary to a Squamous Cell Carcinoma Arising from a Nonhealing Ulcer

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