Malignant Transformation in Chronic Stage IV Sacral Pressure Ulcer: A Case of Marjolin Ulcer

Abstract

A Marjolin ulcer (MU) is a rare type of skin cancer that most commonly occurs in burns and other traumatic scars, and it also may arise in chronic, poorly healing wounds. Typically, MU presents as a squamous cell carcinoma and has a high rate of metastasis resulting in poor prognosis. The mechanism of the aggressive and metastatic potential of MU has not been clearly defined. This malignancy is more common in patients who are elderly or immunocompromised and has also been characterized as a disease of economically developing nations in which health care resources are less abundant and treatment is delayed. Marjolin ulcer is a challenging, although rare, disease. This article presents a case of MU that arose in a chronic sacral pressure ulcer. This was a rare, multifactorial case; the patient’s many comorbidities required coordinated efforts by wound care, oncology, and infectious disease specialists. As seen in this case, MU can be insidious and may not become apparent until considerable progression has occurred. This article discusses the multidisciplinary treatment measures undertaken for this patient, the strategies for prophylaxis and early detection of MU, and ultimately, the poor prognosis of MU in such a scenario where diagnosis is delayed.

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

“…[ 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. [ 3 ] In our case, because the initial diagnosis was only squamous dysplasia, we firstly considered wide excision with reconstruction; however, the tumor infiltrated the deep margin, and the massive intraoperative blood loss was fatal.…”

“…Compared with other studies, demonstrating > 80% mortality rate within 18 months in pressure sore-specific MU, [ 15 , 16 ] our case showed better outcomes. [ 7 , 12 – 14 ] We believe that radical excision is the key to long-term survival. Therefore, limb sacrifice is sometimes necessary, especially in SCC with bony involvement or arising from a deep pressure ulcer.…”

A 3D-Printed Model for High Sacrectomy of a Marjolin’s Ulcer–Associated Sacral Tumor: A Case Report and Literature Review

“…Marjolin's ulcers represent a unique subset of squamous cell carcinomas, emerging primarily within burn scars or chronic wounds and notorious for their aggressive malignant transformation 2,4,6,11,13,18) . Malignant tumors of the sacrum do not respond well to chemotherapy or radiotherapy.…”