Marjolin Ulcer: Clinical Experience with 34 Patients over 15 Years

Abstract

Background: Malignancies that arise from scars are referred to as Marjolin ulcers. The association between chronic ulcers and squamous cell carcinomas is well established. There are many case reports in the literature regarding Marjolin ulcer; however, randomized controlled clinical series that describe a thorough evaluation of these patients are rarely encountered.Objective: We present our clinic's 15 years of experience with 34 Marjolin ulcer patients and their treatment modalities.Methods: A retrospective analysis of 302 squamous cell carcinoma patients who were treated in the plastic surgery department between 1997 and 2011 was performed. Thirty-four (10.3%) histopathologically confirmed Marjolin ulcer patients were further analyzed.Results: Although burn scars represented 77% of the patients in the present study, unstable scars that formed following traffic accidents and fistula tracts are also among the commonly encountered etiologies. Based on our observations, squamous cell carcinoma, in addition to malignant melanoma and verrucous carcinoma, is frequently observed in cases of Marjolin ulcers. Conclusion:If the goal is to eradicate this clinical entity, all of the chronic ulcers that fail to heal require biopsies at regular intervals. Large excisional margins, lymphadenectomies in cases of palpable lymph nodes, and a well-defined oncology protocol are all essential in treating Marjolin ulcer. Contexte: Les tumeurs malignes qui se dé veloppent aux dé pens des cicatrices sont appelées ulcè res de Marjolin. L'association entre les ulcè res chroniques et les carcinomes squameux est bien connue. La documentation contient de nombreux exposé s de cas d'ulcère de Marjolin, mais très peu de sé ries de cas cliniques, comparatives et alé atoires, faisant état d'une é valuation complè te des patients touchés. Objectif: Il sera question de notre expé rience accumulé e pendant 15 ans, dans notre é tablissement, chez 34 patients atteints d'un ulcè re de Marjolin ainsi que des diffé rentes formes de traitement. Mé thode: Il s'agit d'une analyse ré trospective de 302 cas de carcinome squameux, traité s au service de chirurgie plastique, de 1997 à 2011; 34 (10.3%) d'entre eux ont fait l'objet d'une analyse approfondie, l'examen histopathologique ayant ré vé lé la pré sence d'un ulcè re de Marjolin.Ré sultats: Les cicatrices de brû lure constituaient 77% des cas retenus dans l'é tude, mais les cicatrices instables, qui se forment à la suite d'accidents de la route, et les trajets fistuleux figurent aussi parmi les causes courantes de cette affection. D'aprè s les notes recueillies, le carcinome squameux, outre le mé lanome malin et le carcinome verruqueux, s'observe souvent dans les cas d'ulcère de Marjolin.Conclusions: Si le but est d'é liminer cette entité morbide, les biopsies à intervalles ré guliers s'imposent dans tous les cas d'ulcè re chronique qui ne cicatrise pas normalement. La ré alisation de bonnes marges saines, les lymphadé nectomies dans les cas de noeuds lymphoïdes palpables et l'é tablissement d'un protoco...

Systematic Review of Modern Case Series of Squamous Cell Cancer Arising in a Chronic Ulcer (Marjolin's Ulcer) of the Skin

“…The mean age at diagnosis of Marjolin’s ulcer ranged in studies from 30 to 76 years, with a median value of 51 years. Series included patients from Das 3 (n = 46 patients), Smith 6 (n = 21), Shen 12 and Yu 1 (n = 68), Combemale 13 (n = 80), Reich-Schupke 10 (n = 30), Shala 17 and Sadegh Fazeli 15 (n = 102), Kadir 16 (n = 48), Tahir 11 (n = 36), Chalya 8 (n = 56), and Karasoy Yesilada, 9 , Aydogdu, 7 and Oruc 14 (n = 112; Fig 2 ). Except for France and Germany, all series were for patients (n = 489) from low- or middle-income countries (LMICs) according to the World Bank Country Income Classification for 2010.…”

“… 6 , 7 The 2 series reporting on median tumor size reported a median of 8 cm (range, 2-16 cm) and 10 cm (range, 2-25 cm), respectively. 8 , 9 …”

“…Almost a third (30%) of cases was assessed to have clinical involvement—though, among the 8 series reporting on pathologic status of lymph nodes considered clinically involved, only 7% of patients (24 of 334 patients) had pathologically involved disease. 1 , 3 , 6 , 9 , 10 , 12 - 14 Specifically, only 28% of patients undergoing biopsy and/or dissection for clinically involved nodes had pathologic involvement (24 of 85 patients). There was little difference in reported lymph node status between the 2 high-income country cases series and the 12 series from LMICs.…”

“…In some cases, radiotherapy was used in addition to other treatments. For example, Karasoy Yesilada et al 9 used adjuvant radiotherapy in 18 of 34 cases. In total, of 465 patients with treatment information, 41 patients received radiotherapy as part of their primary management, though only 7 received it without surgery.…”

Clinicopathological evaluation of Marjolin ulcers over two decades

“…With today's knowledge, the preferred method of treatment for Marjolin ulcers is wide local excision with two to four cm safety margins [9,23]. Number of biopsies taken before the surgery is an important issue too.…”