Marjolin’s Ulcer: A Preventable Complication of Burns?

Abstract

Marjolin's ulcer is a rare and aggressive cutaneous malignancy that arises on previously traumatized and chronically inflamed skin, especially after burns. This clinical condition was first described by Marjolin in 1828. The term "Marjolin's ulcer" has been generally accepted to refer to a long-term malignant complication of the scars resulting from burns. However, vaccination, snake bites, osteomyelitis, pilonidal abscesses, pressure sores, and venous stasis may also induce this tumor. Clinically, reports suggest that atrophic and unstable scars tend to develop into cancer. Various etiological factors have been implicated in the condition, including toxins released from damaged tissues, immunologic factors, cocarcinogens, and miscellaneous factors such as irritation, poor lymphatic regeneration, antibodies, mutations, and local toxins. The incidence of burn scars undergoing malignant transformation has been reported to be 0.77 to 2 percent. All parts of the body can be affected, but the extremities and the scalp are most frequently affected. There are two variants: acute and chronic. In the former, the carcinoma occurs within 1 year of the injury. The chronic form is more frequent and malignancy tends to develop slowly, with an average time to malignant transformation of 35 years. Although many different cell types can be seen in these lesions, the major histological type is squamous cell carcinoma. Marjolin's ulcers are generally considered as very aggressive tumors with a higher rate of regional metastases; radical excision is the treatment of choice, but there is no consensus on lymph node dissection. Marjolin's ulcer can be insidious and often leads to a poor prognosis, and deaths from Marjolin's ulcer are not uncommon. Meticulous wound care is a crucial step in prevention of these lesions.

Epidemiology and predictors of recurrence of Marjolin’s ulcer: experience from Mansoura Universityxs

“…4,9 Although controversial, regional lymphadenectomy in clinically palpable/radiologically suspicious nodes or in pathologically proven high-grade cancers is undertaken by many scholars. 10 Lymphatic 'mapping' and sentinel-node biopsy are not feasible in MUs occurring in areas of extensive scarring due to a low prevalence of detection. 11 In our study, 6 patients underwent inguinal block dissection (which revealed negative nodes in 1 patient) and 1 patient underwent axillary dissection based on clinical and radiological data.…”

Development of Marjolin’s ulcer within one month of burn injury with synchronous primary lung squamous cell carcinoma in an elderly patient: report of a case with allelotyping

“…Though the original description of Marjolin's ulcer was in the context of squamous cell carcinoma arising from chronic scarring due to thermal injury, there have been reports documenting the association of both mesenchymal malignancies as well as carcinomas other than squamous cell carcinomas that have arisen from chronic non-thermal injuries [2]. There are two types of Marjolin's ulcers: an acute type that develops within 1 year of injury and a chronic type that develops after a latency period averaging 31 years [3,4].…”

Early Transformed Diabetic Foot Ulcer into a Malignancy: A Case Report

“…Less frequently, it manifests as an exophytic lesion that is similar to granular tissue. [7][8][9] Given the nature of diabetic foot wherein ulcers do not go away until they are completely cured, it was hard to suspect carcinoma when the patient was initially hospitalized. Even two years later, the patient did not show any clinical abnormalities except the uncured ulcers and granulation tissue.…”

“…[7][8][9] Skin grafting is also actively considered for skin lesion reconstruction. Although preventive lymph node dissection is not recommended, some researchers prefer the technique due to the aggressive nature of Marjolin's ulcers.…”