Úlcera de Marjolin: relato de 12 casos

Abstract

Relato de 12 casos de úlcera de Marjolin observados de 1990 a 2003 no HUCFF-UFRJ. Cinco pacientes do sexo feminino e sete do masculino, com idade variando de 38 a 86 anos. Tempo de evolução de 10 a 50 anos, da cicatriz até surgimento do carcinoma espinocelular. Ressecção da lesão em dois casos e amputação terapêutica em oito. Em um caso realizada exérese paliativa da lesão por apresentar metástase para coluna sacrococcígea. Um caso de impossibilidade terapêutica. Concluiu-se que a biópsia é essencial em úlceras crônicas, para diferenciar carcinoma espinocelular de hiperplasia pseudoepiteliomatosa.

Caso para diagnóstico

“…6 However, it is controversial whether prophylactic regional lymph node resection and radiotherapy are indicated. 3,5 The case reported here illustrates the potential aggressiveness of the lesion. The principal differential diagnoses for the lesion on the patient's thigh associated with adenopathy consisted of venereal lymphogranuloma, soft chancre and syphilis.…”

“…3 Marjolin's ulcers usually develop on old burn wounds. 2,5,6 Nevertheless, there have been reports of the lesion in stasis ulcers, 7 cutaneous lupus, 1 osteomyelitis fistula, 1,5,6 syphilitic lesions, dermatitis artefacta and congenital epidermolysis bullosa. 4 The condition occurs in adults, with no preference for age or race.…”

“…3,9 Squamous cell carcinoma is the most common type of malignancy, occurring in 75-96% of cases, 2,3 and it tends to be more aggressive compared to carcinomas that are unassociated with skin scars. 5,6,9 Marjolin's ulcer is one of the ten most common clinical subtypes of this form of cancer. 10 Cases have also been reported of basal cell carcinomas (1-25% of cases) and, less commonly, melanomas and sarcomas.…”

“…There is a consensus on the importance of repeat trauma to the scar. 2,3,5,9 Inappropriate treatment may also represent a critical factor. The interval between the initial skin aggression and the appearance of the neoplasia varies from 31 to 42 years.…”

Úlcera de Marjolin associada a ulceração e osteomielite crônicas

“…2 According to some studies, treatment depends on factors inherent to the patient (age, comorbidities) and to the tumor itself (site, extension and the presence or absence of metastases) and must therefore be individualized. 6 Because of the advanced stage of the tumor at the time of diagnosis, the treatment of choice for most patients consists of radical resection with or without lymph node removal or irradiation, leaving a surgical margin of no less than 1 cm. Amputation is indicated in cases of deep dermal invasion, bone Other forms of treatment such as cryotherapy, radiotherapy and chemotherapy were not found to be effective and are reserved for palliative use in patients for whom surgery is contraindicated.…”