Squamous Cell Carcinoma (Marjolin’s Ulcer) Arising in a Sacral Decubitus Ulcer Resulting in Humoral Hypercalcemia of Malignancy

Abstract

Long-standing burns, fissures, and ulcers that undergo malignant transformation into a variety of malignancies, including squamous cell carcinoma, is commonly referred to as a Marjolin's ulcer. It is well recognized that squamous cell carcinomas of the lung and esophagus can cause humoral hypercalcemia of malignancy secondary to paraneoplastic secretion of parathyroid hormone-related peptide. However, it is extremely rare for a squamous cell carcinoma developing in a sacral decubitus ulcer to cause humoral hypercalcemia of malignancy. We describe the first case of a patient found to have elevated serum levels of parathyroid hormone related peptide related to his Marjolin's ulcer. A 45-year-old African American man with T6 paraplegia and a sacral decubitus ulcer present for 20 years was admitted for hypercalcemia of unclear etiology. He was subsequently found to have elevated parathyroid hormone related peptide and an excisional biopsy from the ulcer showed invasive squamous cell carcinoma suggestive of humoral hypercalcemia of malignancy. The patient ultimately succumbed to sepsis while receiving chemotherapy for his metastatic squamous cell carcinoma. Humoral hypercalcemia of malignancy is a rare and likely underrecognized complication that can occur in a Marjolin's ulcer.

Marjolin’s ulcer in an ischial pressure sore presented with necrotizing soft tissue infection: A case report

“…Regarding the location and treatment of pressure sore-related MU, most patients with spinal cord injuries developed pressure sore-related MU in sacral and ischial areas, which were hypervascular with rich lymphatic drainage to the pelvic region, explaining the high-metastatic rate. [ 12 ] It corresponded to the rapid progression toward the skeletal system, with secondary osteomyelitis, [ 1 , 12 , 13 ] or even distant metastasis. [ 7 , 14 ] Therefore, the optimal treatment for pressure sore carcinoma were early wide surgical resection and lymph node dissection; radiation was used as palliative or adjuvant treatment.…”

Giant cutaneous squamous cell carcinoma of the scalp arising in the setting of folliculitis decalvans

“…However, instead of UV radiation damage, the primary aetiology in this case is presumptively chronic inflammation and the scarring process. Chronic scarring and inflammation are among the most critical risk factors for SCC development in AAs, in scenarios such as Marjolin’s ulcer, discoid lupus erythematosus and hidradenitis suppurativa 7–10…”

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

“…It is well recognized that SCC of the lung and other solid organs can secrete PTHrP, resulting in hypercalcemia (2,4). Only a few reports are available associating HHM with primary cutaneous SCC arising from the chest wall (1,2,4), burn scars (5,6), and decubitus ulcer (7). Some cases of SCC were associated with hidradenitis suppuritiva (8) or recessive dystrophic epidermolysis bullosa (9).…”