Prognostic Factors of Marjolin Ulcers: A Meta-Analysis and Systematic Review Assisted by Machine Learning Techniques

Abstract

Marjolin ulcer (MU) is a malignant tumor that commonly arises from previously injured skin, including burn injuries, traumatic wounds, scars, and other chronic nonhealing inflammatory conditions. It most often develops in deep burn wounds with a prolonged Background: Marjolin ulcers (MUs) are malignant tumors arising from previously injured skin, including burn wounds, scars, chronic ulcers, and other chronic nonhealing inflammatory conditions. They have a potentially long latent period. The authors aimed to establish the prognostic factors for recurrence, metastasis, and disease-specific death related to MU. Methods: The authors performed a comprehensive search of PubMed, Embase, and the Cochrane Library. After assessing the methodologic quality of case series, they performed a meta-analysis and systematic review. Furthermore, the authors used machine learning to predict patient survival time. Results: MUs on the upper limbs, head, and neck had a higher risk of recurrence. Contrastingly, lower grade lesions, absence of lymph node metastasis, and a tumor diameter of less than 10 cm were associated with lower recurrence risk. The risks were unrelated to age and latent period. In addition, patients without lymph node metastasis had a lower risk of developing distant metastasis. Furthermore, the risk of disease-specific death was lower in patients with a lower tumor grade, absent lymph node metastasis, small tumor diameter (<10 cm), and tumors located in regions other than the head and neck. Correlation analysis showed that the age at initial injury was negatively correlated with the latent period of MU. Conclusions: The authors found that tumor grade, tumor site, lymph node status, and tumor size are important predictors of a worse prognosis. To integrate these predictors, the authors created an equation to predict the survival time for individual patients by means of machine learning processes. Moreover, the authors found that MU developed more quickly in older individuals with injuries.

Management of Marjolin's ulcer with popliteal lymphadenopathy with surgical resection and lymphadenectomy in a young patient, an uncommon lesion and overlooked entity: A case report

“…Though clinical presentation and examination are essential for initial evaluation, histological analysis via biopsy is the mainstay for diagnosing MU 1,3 . Histology reveals a well‐differentiated squamous cell carcinoma in most cases 5,7,11 . Other less commonly reported histological variants are basal cell carcinoma, melanoma, and sarcoma 11 .…”

“…The majority of patients with MU present with rapidly growing exophytic non‐healing ulcers 2,3,5 . In approximately three‐fifths of MU cases, lower extremities are involved 5,7 . Other sites such as the scalp, face, upper extremities, and trunk can also be involved 5,7 .…”

“…Such lesions may be overlooked or ignored, and years later, they develop the malignant transformation of cells 1 . Though MU can occur in any body part, the lower extremities are the most commonly affected 3,5–7 . The mainstay of diagnosing MU is histological analysis via biopsy 1,3 .…”

“…The mainstay of diagnosing MU is histological analysis via biopsy 1,3 . MU's most prevalent histological type is squamous cell carcinoma (SCC) 5–7 . MU can have a dreadful prognosis, even causing death, as it is often diagnosed in the advanced stage due to its insidious onset 3,7 .…”

“…3,7 Factors such as tumor grade, tumor site, distant metastasis, and lymph node can determine the prognosis in these patients. 3,7 The best…”