Introduction. Marjolin's ulcer is a skin malignancy that occurs on a scar or
chronic wound. It most commonly occurs on a burn scar. Squamous cell
carcinoma is the most common type of tumor, in more than 90% of cases. The
rate of this rare malignant transformation is 1-2%. Marjolin's ulcer is more
aggressive than other skin cancers. Wide excision is the treatment of
choice. Recurrences are common. The aim of this article is to present a
large exophytic carcinoma of the lower leg as a rare form of this tumor
according to the size and type. The result of the radical surgery with
reconstruction is also presented. Case report. Male patient, aged 52 years
was presented by large exophitic tumor on the left lower leg. Tumor was
located at the site of the previous gunshot injury. Latent period was 22
years. Tumor size was 14x12cm. Wide excision was performed (2-cm surgical
margin) including the deep fascia and the defect was closed by split
thickness skin graft from the opposite thigh. Histology showed well
differentiated squamous cell carcinoma. There were no regional or distant
metastases. One year after surgery there was no recurrence of the tumor.
Conclusion. Early diagnosis of Marjolin's ulcer and wide excision are
mandatory. Surgical margins for excision should be 2 cm and excision should
include deep fascia. Multiple and repeated biopsies of the chronic wounds
are advised. There is no consensus on staging of the Marjolin's ulcer and
lymph node dissection.