Marjolins Ulcer: Clinicopathological Profile and Treatment Patterns

• B.R. Kiran Kumar

  Department of Radiation Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, India

• Geeta S. Narayanan

  Department of Radiation Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, India

• M.S. Ganesh

  Department of Surgical Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, India

• Amritha Prabha Shankar

  Department of Surgical Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, India

Purpose: Marjolins ulcer is a malignant transformation arising from chronic ulcers or previously traumatized scars that occur usually after burns. This article aims to study the clinicopathological profile and treatment patterns of Marjolins ulcer.

Materials and Methods: Retrospective analysis of all Marjolins ulcer patients presented to Vydehi Cancer Centre from 2018 to 2021 was done. A total of 27 patients of all age groups were included in the study. All information regarding detailed history, clinical examination, treatment details were retrospectively collected and analysed.

Results: Most of the patients were in the 5th decade of life with an overall male preponderance. The most common cause for Marjolins ulcer was Burns scars followed by Trauma. Lower extremities were found to be the most predominant site. The mean latency period for the development of Marjolins ulcer was 11 years. Squamous cell carcinoma was the most common histological subtype, Adjuvant Radiotherapy was given to the patients with high-risk features.

Conclusion: Chronic non-healing ulcers that do not respond to treatment should be carefully examined for malignant transformation. Surgery is the mainstay of treatment and Adjuvant Radiotherapy should be considered in high-risk cases to reduce locoregional recurrence.

Eray Copcu Marjolin's ulcer: a preventable complication of burns? Plast Reconstr Surg 2009; 124(1): 156e-164e. https://doi.org/10.1097/PRS.0b013e3181a8082e

Dupree MT, Boyer JD, Cobb MW. Marjolin’s ulcer arising in a burn scar. Cutis 1998; 62: 49e51.

Pekarek B, Buck S, Osher L. A comprehensive review on Marjolin’s ulcers: diagnosis and treatment. Te Journal of the American College of Certifed Wound Specialists 2011; 3(3): 60-64. https://doi.org/10.1016/j.jcws.2012.04.001

Tao J, Zhang X, Guo N, et al. Squamous cell carcinoma complicating discoid lupus erythematosus in Chinese patients: review of the literature, 1964-2010. J Am Acad Dermatol 2012; 66(4): 695-696. https://doi.org/10.1016/j.jaad.2011.09.033

Tavares E, Martinho G, Dores JA, Vera-Cruz F, Ferreira L. Marjolins ulcer associated with ulceration and chronic osteomyelitis. An Bras Dermatol 2011; 86(2): 366-9. https://doi.org/10.1590/S0365-05962011000200026

Bloemsma GC. Oren Lapid Marjolin's ulcer in an amputation stump. J Burn Care Res 2008; 29(6): 1001-3. https://doi.org/10.1097/BCR.0b013e31818ba0bf

Asuquo ME, Ikpeme IA, Ebughe G, Ekpo E Bassey Marjolin's ulcer: Sequelae of mismanaged chronic cutaneous ulcers. Adv Skin Wound Care 2010; 23(9): 414-6. https://doi.org/10.1097/01.ASW.0000383211.18782.2a

Fazeli MS, Lebaschi AH, Hajirostam M, et al. Marjolin's ulcer: clinical and pathologic features of 83 cases and review of literature. Medical Journal of the Islamic Republic of Iran 56 (2013): 215-229.

Copcu E: Marjolin’s ulcer: A preventable complication of burns? Plast Reconstr Surg 2009; 124: 156e-164e. https://doi.org/10.1097/PRS.0b013e3181a8082e

Ortiz BD, Riveros R, Gabriela MB, et al. Marjolin ulcer: a case report. Our Dermatol Online 2014; 5: 51-53. https://doi.org/10.7241/ourd.20141.12

Wronski K. Marjolin’s ulcer of the thigh after burn injury- case report and review of literature. New Medicine 2014; 18: 69-75.

Nthumba PM. Marjolin's ulcers: theories, prognostic factors and their peculiarities in spina bifida patients. World Journal of Surgical Oncology 2010; 8: 1-5. https://doi.org/10.1186/1477-7819-8-108

Treves N. The development of cancer in burn scars: an analysis and report of thirty-four cases. Surg Gynecol Obstet 1930; 51: 749-82.

Neuman Z, Ben-Hur N, Shulman J. Trauma and skin cancer: Implantation of epidermal elements and possible cause. Plastic and Reconstructive Surgery 1963; 32: 649-56. https://doi.org/10.1097/00006534-196312000-00009

Onesti MG, Fino P, Fioramonti P, Amorosi V, Scuderi N. Ten years of experience in chronic ulcers and malignant transformation. Int Wound J 2013. https://doi.org/10.1111/iwj.12134

Sharma A, Schwartz RA, Swan KG. Marjolin's warty ulcer. J Surg Oncol 2011; 103: 193-195. https://doi.org/10.1002/jso.21783

Hahn SB, Kim DJ, Jeon CH. Clinical study of Marjolin's ulcer. Yonsei Medical Journal 1990; 31: 234-241. https://doi.org/10.3349/ymj.1990.31.3.234

Shahla A. An overview of heel Marjolin's ulcers in the Orthopedic Department of Urmia University of Medical Sciences 2009; 12: 405-408.

Chalya PL, Mabula JB, Gilyoma JM, et al. Early Marjolin’s ulcer developing in a penile human bite scar of an adult patient presenting at Bugando Medical Centre, Tanzania: A case report. Tanzania Journal of Health Research 2012; 14: 82-95. https://doi.org/10.4314/thrb.v14i4.8

Cruickshank AH, McConnell EM, Miller DG. Malignancy in scars, chronic ulcers, and sinuses. Journal of Clinical Pathology 1963; 16: 573-580. https://doi.org/10.1136/jcp.16.6.573

LH K. Carcinoma within a chronic burn scar (Marjolin's ulcer). Report of a case. The Medical Annals of the District of Columbia 1964; 33: 620-622.

Chalya PL, Mabula JB, Rambau P, et al. Marjolin's ulcers at a university teaching hospital in Northwestern Tanzania: a retrospective review of 56 cases. World Journal of Surgical Oncology 2012; 10: 1-8. https://doi.org/10.1186/1477-7819-10-38

Aydogdu E, Yildirim S, Aksz T. Is surgery an effective and adequate treatment in advanced Marjolin's ulcer? Burns 2005; 31: 421-431. https://doi.org/10.1016/j.burns.2005.02.008

Cruickshank AH, McConnell EM, Miller DG. Malignancy in scars, chronic ulcers, and sinuses. Journal of clinical pathology 1963; 16: 573-580. https://doi.org/10.1136/jcp.16.6.573

Asuquo ME, Nwagbara VI, Omotoso A, et al. Marjolin’s ulcer: mismanaged chronic cutaneous ulcers. J Clin Exp Dermatol Res 2013; S 6: 228-239. https://doi.org/10.4172/2155-9554.S6-015

Bauer T, David T, Rimareix F, et al. Marjolin's ulcer in chronic osteomyelitis: seven cases and a review of the literature. Revue de chirurgieorthopedique et reparatrice de l'appareilmoteur 2007; 93: 63-71. https://doi.org/10.1016/S0035-1040(07)90205-6

Kirsner RS, Spencer J, Falanga V, Garland LE, Kerdel FA. Squamous cell carcinoma arising in osteomyelitis and chronic wounds: treatment with Mohs micrographic surgery vs amputation. Dermatol Surg 1996; 22(12): 1015-1018. https://doi.org/10.1111/j.1524-4725.1996.tb00654.x

Tϋregϋn M, Nişanci M, Gϋler M. Burn scar carcinoma with longer lag period arising in previously grafted area. Burns 1997; 23(6): 496-497. https://doi.org/10.1016/S0305-4179(97)00041-7

Battaglia M, Treadwell T. Marjolin's ulcer. Alabama Nurse 2008-2009; 35(4): 4.

Ozek C, Cankayah R, Bilkay U, Cagdas A. Marjolin's ulcers arising in burn scars. J Burn Care Rehabil 2001; 22: 384-389. https://doi.org/10.1097/00004630-200111000-00006

Visuthikosol V, Boonpucknavig V, Nitiqanant P. Squamous carcinoma in scars: clinicopathological correlations. Ann Plast Surg 1986; 16(1): 42-48. https://doi.org/10.1097/00000637-198601000-00004

Agale SV, Kulkarni DR, Valand AG, Zode RR, Grover S. Marjolin's ulcer-a diagnostic dilemma. J Assoc Physicians India 2009; 57: 593-594.

Jellouli-Elloumi A, Kochbati L, Dhraief S, Ben Romdhane K, Maalej M. Cancers arising from burn scars: 62 cases. Ann Dermatol Venereol 2003; 130: 413-416.

• PDF

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.