Clinical study of Marjolin's ulcer

Abstract

Marjolin's ulcer is the malignant lesion which develops in a burn scar or chronic fistula. Due to the low prevalence of this lesion, there has been disagreement regarding its clinical features, methods of treatment, and prognosis. We evaluated 19 cases of patients who had been admitted to Severance Hospital from Jan. 1970 to Dec. 1985. The results were as follows: The previous lesion was a burn scar in 52% of the cases and a fistula of chronic osteomyelitis in 32%. The mean latent period was 31.5 years. The initial symptoms were increased pain (74%), discharge with foul odor (68%) and bleeding (58%). Upon histological examination, all of the cases were squamous cell carcinoma. The rate of metastasis at the time of diagnosis was 32%. Of the 16 patients treated by surgery, local recurrence was noted in 4 cases. Three of these cases were patients who had been treated by excision and split thickness skin graft. The time interval for local recurrence ranged from 6 months to 11 months (average 8.8 months). In conclusion, the squamous cell carcinoma of marjolin's ulcer seems to have a worse prognosis than other squamous cell carcinomas and it requires aggressive treatment. The burn scar or chronic fistula that occurs in elderly patients especially requires more adequate treatment and close observation.

Caso para diagnóstico

“…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.…”

“…According to the literature, the incidence of metastases at the time of diagnosis is 32%. 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.…”

“…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.…”

“…Nevertheless, cases have been reported in which the lesion developed within three months of the initial trauma and others in which onset occurred only after 70 years. 6,8 The principal initial symptoms include local pain (74%), a fetid secretion (68%) and bleeding or hemorrhage (58%). 6 The lesions are most often located on the limbs (70-88%), 3,9 although there have been reports of neoplasia in the neck, trunk and scalp.…”

“…6,8 The principal initial symptoms include local pain (74%), a fetid secretion (68%) and bleeding or hemorrhage (58%). 6 The lesions are most often located on the limbs (70-88%), 3,9 although there have been reports of neoplasia in the neck, trunk and scalp. 3 In general, the lesions consist of flat ulcers, with a granular base, thick or elevated borders and a hardened base, 2,3 or tumors.…”