Marjolin Ulcer: A Comprehensive Review

Abstract

This article aims to provide a comprehensive review of Marjolin ulcer (MU) to assist clinicians in understanding the epidemiology, etiology, pathogenesis, diagnosis, and treatment of MU. Marjolin ulcer presents with clear signs and symptoms of malignant degeneration in chronic wounds. It can be prevented by raising awareness and educating wound care providers appropriately about its signs and symptoms. GENERAL PURPOSE To provide a comprehensive review of Marjolin ulcer (MU) to assist clinicians in understanding the epidemiology, etiology, pathogenesis, diagnosis, and treatment of MU. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will: 1. Describe the epidemiology, pathogenesis, and clinical manifestations of MU. 2. Summarize the diagnostic and treatment approaches for patients who have an MU.

Chronic wounds: Treatment consensus

“…CT scans and magnetic resonance imaging (MRI) scans may also assist in the diagnosis of osteomyelitis though MRI may overcall bony involvement. Very long‐standing wounds, of many years' duration may necessitate biopsy of the normal skin/wound interface to rule out Marjolin's ulceration, a particularly aggressive form of squamous cell cancer 27 …”

Marjorin ulcer (squamous cell carcinoma) in a temporal artery biopsy wound

“…An alternative narrative to explain the seemingly acute onset of malignancy in a scar is that the injured state accelerated an already preexisting process of carcinogenesis. 1 In our patient, no note was made by the TAB surgeon of a suspicious lesion at the site of the biopsy, and the procedural approach for TABs at our centre emphasizes avoiding "suspicious" skin changes for the selected site of incision. Yet, without a preoperative photograph, we cannot rule out the possibility of more subtle actinic skin changes in this white patient with blue eyes (Fitzpatrick 1À2), who inherently has a higher risk of skin cancer.…”

“…It is well recognized that postoperative and traumatic wounds and scars are susceptible to malignant degeneration, most commonly to squamous cell carcinoma (SCC). 1 This phenomenon can occur months to decades after the inciting trauma. 1 We describe a case arising from a temporal artery biopsy (TAB) site, demonstrating the importance of considering skin malignancy in any nonhealing incision.…”

“…1 This phenomenon can occur months to decades after the inciting trauma. 1 We describe a case arising from a temporal artery biopsy (TAB) site, demonstrating the importance of considering skin malignancy in any nonhealing incision. Informed consent for publication of this patient's case was obtained, adhering to the Declaration of Helsinki principles.…”

“…The term marjorin ulcer or scar carcinoma is often used to refer to malignancy arising from chronic wounds or scars. 1 The most common malignancy to arise from a scar is SCC, although other malignancies such as basal cell carcinoma, melanoma, and sarcoma have been reported less frequently. 2 The scar-related SCC are known to have a more invasive course and a greater tendency to metastasize.…”