Marjolin ulcer: an overlooked entity

Abstract

Marjolin ulcer is a well-defined, but uncommon malignant ulcer that occurs in chronic wounds and cutaneous scars. Jean-Nicolas Marjolin was credited with describing this phenomenon in 1828. This entity is frequently overlooked and therefore inadequately treated leading to a poor prognosis. The malignant transformation of an ulcer is most commonly associated with burn scars, but has been reported in many other types of chronic, non healing wounds such as traumatic wounds, venous stasis and chronic pressure ulcers, fistulas, lacerations and leprosy ulcers. Development of malignancy tends to be slow with an average time of approximately 25 years. Various theories concerning pathogenesis of Marjolin ulcer have been proposed. Well-differentiated squamous cell carcinoma (SCC) is the most common histological type of Marjolin ulcer. Biopsy with histopathologic interpretation remains the gold standard for the diagnosis, with radical surgical excision being the treatment of choice. A high index of suspicion should be held by any health care provider when evaluating a chronic, non healing wound. This is a case report of a Marjolin ulcer arising on the left buttock of a patient with a long-standing history of a traumatic wound.

A Case of Squamous Cell Carcinoma of the Scalp After Several Synthetic Hair Grafts

“…However, no actual report of the evolution of any neoplasms as artificial hair implantation-related complications has ever been clearly reported in literature. Our case includes many clinical features that support a likely dependence of the neoplastic degeneration on the sequelae of the processes of artificial hair implantation and to the additional effect of irritant synthetic fibers [9][10][11][12][13][14]. The latency of the degeneration (the chronic variant of Marjolin's ulcer is reported to have an average lag of 35-46 years), the affected area, the typical clinical history characterized by repetitive local irritation and microtrauma, the occasional presence of bacterial infection and the prolonged actinic damage are all features that strongly suggest a clear pathophysiologic process.…”

“…The neoplasms were possibly related to a recurrent local injury, repetitive irritation, and microtrauma similar to Marjolin's ulcers that occurred at a chronic scar with a latency of 20-30 years [9][10][11][12][13][14].…”

Latissimus dorsi free flap reconstruction of major abdominal defect in treatment of giant Marjolin’s ulcer: a short report focused on preoperative imaging

“…Although regional lymph nodes are the most frequent site of metastasis, liver lung, brain, kidney, and other distant metastases can also be observed (9). In a tumor of the size and location presented in the current case, sentinel node biopsy would be pointless.…”

Marjolin’s ulcer

“…10 Marjolin's ulcers can have a long latency period from the time of the original injury until malignant transformation, with an average time of 29 years reported in a recent review. 1 Chronic wounds such as pressure sores in patients with spinal injury may be insensate, so patients may not be aware of changes to the wound.…”