Systematic Review of Modern Case Series of Squamous Cell Cancer Arising in a Chronic Ulcer (Marjolin's Ulcer) of the Skin

Abstract

PURPOSE Marjolin's ulcer is an aggressive cutaneous malignancy that arises in chronic nonhealing wounds. A review of modern series describing Marjolin's ulcer would be helpful in defining optimal management strategies and expected outcomes. METHODS A systematic review was performed on October 18, 2018, by querying Medline and EMBASE. Key inclusion criteria were as follows: human studies, English language, published in 2000 or later, > 10 patients, and at least 80% of the patients having squamous cell carcinoma (SCC) histology. RESULTS There were 599 patients in 14 case series from 10 countries; 82% of patients were from low-income and middle-income countries, and 48% were women. Overall, 65% of the ulcers were preceded by burns. Mean latency ranged from 11 years to 41 years (median, 28 years). Lower extremities were the most common site (62%). Differentiation was reported as well differentiated (64%), moderately differentiated (27%), or poorly differentiated (9%). Almost one third of cases were clinically node positive, though only 7% of all cases (24 of 334) were confirmed to be pathologically involved. Distant metastasis rates were reported in only 7 series, with median rate of 5% (range, 0%-27%). The main treatment modality was surgical excision (71%), followed by amputation (24%), primary radiotherapy (2%), and chemotherapy (< 1%). Outcomes data varied in content and quality. Mortality rates were 12%, 24%, and 37% in the three series reporting between 2 and 3 years of follow-up. CONCLUSION Marjolin's ulcer with SCC histology is an aggressive cancer with a notable potential for lymph node metastasis and distant metastasis. Comprehensive staging is recommended, with management optimally having a multidisciplinary context. Low- and middle-income countries are overrepresented in reports of Marjolin’s ulcer, and there may be opportunities for prevention and early detection.

Prognostic factors of Marjolin’s ulcers: A Meta-analysis and Systemic Review Assisted with Machine Learning Techniques

“…Among patients who demonstrated lymph node enlargement and later underwent lymph node dissection, only 25.7% had lymph node metastasis diagnosed on pathologic examination. Similar to our results, Abdi et al 57 showed that 28% of patients undergoing biopsy or dissection for clinically involved lymph nodes had pathologic involvement (24 of 85 patients). Although metastatic tumor cells may not always be found in enlarged lymph nodes, routine biopsy or lymph node dissection remains necessary.…”

Bước đầu đánh giá hiệu quả xạ trị bề mặt kết hợp phẫu thuật trong điều trị sẹo loét ung thư hóa sau bỏng

“…So sánh với kết quả nghiên cứu của một số tác giả khác: Trong nghiên cứu của tác giả Lê Thế Trung 100% các bệnh nhân là ung thư biểu mô tế bào gai (ung thư biểu mô tế bào vảy -SCC) [4]; Trong báo cáo tổng hợp của Abdi M.A. trên 599 bệnh nhân thấy rằng ung thư biểu mô tế bào vảy chiếm tới 92% [5].…”

Therapeutic Effect and Mechanism of Negative Pressure Wound Therapy with Huoxue Shengji Decoction Instillation for Chronic Skin Ulcers

“…In particular, pressure skin ulcers, skin ulcers complicated by diabetes, and venous ulcers of the lower extremities are the most common CSUs [ 1 ]. As a common and frequently occurring disease, CSUs seriously threaten human health and severe cases may require amputation, cause cancer, and have fatal outcomes [ 2 , 3 ]. With the migration of the disease and the occurrence of related complications, patients and their families have to bear the huge economic burden and psychological obstacles associated with CSUs.…”