Marjolins ulcer is a type of malignant tumor that occurs in scar tissue. Clinical features and treatment of 140 cases of marjolins ulcer at a. Marjolins ulcers at a university teaching hospital in. F2 figure 2 marjolins ulcer with sinuses extending into the thigh and labia majora. Its incidence is estimated to range from 1% to 2% of all burn scars. Management of marjolins ulcer in a chronic pressure sore. Saeedia muhamad shukry 25 years old typist lady from sulaimani, presents to me on 20th nov. They are commonly present in the context of chronic wounds including burn injuries, varicose veins, venous ulcers, ulcers from osteomyelitis, and post radiotherapy scars. The most serious longterm burn scar problem is burn scar carcinoma, also called marjolins ulcer. A new concept in the management of marjolins ulcers.
The mean age of onset is 50 years, and the mean latency at onset is 31 years after injury. Marjolins ulcer is a term used to describe squamous cell carcinomas which develop in chronic wounds. The aim of this study was to define etiology, topography, and histopathology for marjolins ulcer and its surgical management. The term is currently also used for malignant lesions arising from other tissue injuries, such as vaccinations, snake bites. This potentially fatal complication typically occurs after a certain latency period. The term marjolins ulcer was first used by da costa in 1903. The disease course of marjolins ulcer is long and is usually. Case presentation marjolin,s ulcer complaining of nonhealing ulcer in the lower rt. Subjects in six subsaharan marjolins ulcer studies had a mean age between 36 and 42 years, with a mean latent period 16 years. Although originally described in an area of burns scar, many other chronic wounds such as osteomyelitis sinus tracts, venous stasis ulcers and chronic pressure sores have the potential to undergo malignant transformation.
These carcinomas may also develop at the site of longstanding irritation, such as unstable. Finally, this tumor is an uncommon type of skin cancer in the developing countries as strongly emphasized in paredes study. Marjolins ulcer is a rare, aggressive cutaneous malignancy that arises primarily in burn scars but can occur in other types of scars. Note deep ulcer and benign appearance of ulcer edges. Bad prognosis is the characteristic of marjolins ulcer and death from marjolins ulcer is not uncommon.
Commonly these lesions are treated as chronic ulcers and suspicion of malignancy should be raised with crusting, increase in pain or size of the ulcer and bleeding. Marjolins ulcer mu represents malignant degeneration that typically ensues over a period of time in the postburned lesions and scars or any other chronic wound. Although mr images of marjolins ulcer have been reported as nonenhanced, it was highly enhanced in our case. Ct angiography and petct complement mri for evaluating the nature of marjolins ulcers. Marjolins ulcer is a term commonly referred to malignant degeneration of chronic wounds unhealed or healed by secondary intention and most of the cases described. Marjolins ulcer the lsu experience marjolins ulcer the lsu experience barr, louis h menard, john w. A biopsy of the mass revealed invasive squamous cell carcinoma consistent with marjolin ulcer fig. Ppt marjolin,s ulcer powerpoint presentation free to. Provision of early stable wound cover is essential for prevention of malignant degeneration of scars, while early appropriate intervention is crucial in the treatment.
It most commonly forms at the site of an old thermal burn scar. Marjolins ulcers have a grave prognosis, especially when regional nodes are involved. Marjolins ulcer complicating a pressure sore electronic journal. These tumours typically run an aggressive course with a poor prognosis. Marjolins ulcers have a 1% to 2% incidence in all burn scars but can also develop from previously traumatized and scarred tissue of other etiologies such as chronic sinuses of osteomyelitis, posttraumatic wounds, pressure sores.
These lesions are, however, frequently overlooked and often inadequately treated. Squamous cell carcinomas resulting from marjolins ulcers have a much greater tendency to metastasize than squamous cell carcinomas arising from other causes, which makes early diagnosis imperative. A marjolin ulcer is the rare development of cutaneous squamous cell carcinoma scc in the site of a scar or ulcer. Marjolins ulcer is a rare, aggressive skin cancer developing in scar tissue, chronic ulcers and areas affected by inflammations. A biopsy of the mass revealed invasive squamous cell. Wide excision with 3 cm of free margins to the borderbase of the ulcer was performed in every case. Marjolins ulcer is a rare but aggressive squamous cell cancer most often associated with chronic burn wounds. Although burn wounds are the most common type of cutaneous trauma associated with this entity, there are a multitude of possible lesions that may initiate this disease process including traumatic wounds, venous stasis ulcers, and vaccination sites. Marjolins ulcers in subsaharan african have a shorter latent period, and they occur in younger patients.
Ten patients, 5 male and 5 female, ranging in age from 3965 years, were included in this study. Marjolins ulcers are tumours that most commonly arise from areas of chronic inflammation or injury and develop over many years. Marjolins ulcer refers to an aggressive ulcerating squamous cell carcinoma presenting in an area of previously traumatized, chronically inflamed, or scarred skin. Marjolins ulcers in subsaharan africa marjolins ulcers in subsaharan africa nthumba, peter 20100720 00. Marjolins ulcer is a rare and often aggressive cutaneous malignancy that arises in previously traumatized or chronically inflamed skin, particularly after burns. Recent studies suggest such cancers are in an immunologically privileges sites due to the dense scar tissue. Marjolins ulcer is relatively commoner among males than the females 12, and no age is immune to it with individuals from almost all age groups including children being afflicted worldwide 14, 15. Marjolins ulcer mu is a rare malignancy arising from various forms of scars. The prognosis has been shown to be much worse for tumors not having a round cell infiltrate prior to surgery, as in marjolins ulcers. Marjolins ulcers though thoughtto be rare have been reported to have a higher incidence in subsaharan africa. Marjolins ulcer mu is an umbrella term covering squamous cell carcinoma scc, basal cell carcinoma and malignant melanoma that develop in chronic wounds, sinuses or scars.
In the current study, we noticed the preponderance of males. Currently the term marjolins ulcer most accurately describes malignant degeneration of a chronic inflammatory skin lesion, regardless of the origin of the lesion or the type of cancer that develops in the lesion. Marjolins ulcers in subsaharan africa springerlink. The most common type of malignancy reported in a marjolin ulcer is an. Two case studies of marjolins ulcers in patients referred. Marjolin ulcers are malignancies arising in nonhealing cutaneous wounds.
The 2 case studies in this article describe marjolins ulcers occurring in chronic pressure ulcers, which should alert the clinician to the possibility of malignancy in any longstanding wound. Marjolins ulcer is a particular squamous cell carcinoma, an aggressive variety that is found after a long period of latency in chronic wounds, especially in burn scars. Marjolin s ulcers are generally considered as very aggressive tumors with a higher rate of regional metastases. Marjolins ulcer among skin cancers was evaluated to be 1. Marjolins ulcer, squamous cell carcinoma, pressure sore.
In addition to these 10 patients, the authors found 9 cases in the medical literature in which lymphatic mapping and sentinel node biopsy were performed for the treatment of marjolins ulcers. Marjolins ulcer is malignant change in a longstanding ulcer and or scar tissue. Current concepts in the management of marjolins ulcers. This article is from biomedical imaging and intervention journal, volume 2. About 20 years ago, patrick sustained major burns to his legs while fighting a fire at a local factory.
The formation of an epidermoid carcinoma in nonhealing scar tissue, a marjolins ulcer, is a well described neoplasm. Although rare, on mr, a marjolins ulcer should be considered when a wellenhanced softtissue mass with a broad based skin ulcer shows a mass effect and invasion of the adjacent bone. When dealing with marjolins ulcer, the latency period can be misleading since it may occur even. Scar carcinoma is also known as marjolins ulcer, named after the french surgeon marjolin who first described a tumor arising from burn scars in. Abstractchronic wounds and scar tissues are prone to skin cancer. Marjolins ulcer with sinuses included within surgical excision margins. However, marjolin ulcers may also form from osteomyelitic lesions and, rarely, venous ulcers, pressure sores, surgical scars, animal bites, and vaccination scars 1. A marjolin ulcer is a rare and aggressive type of skin cancer that grows from burns, scars, or poorly healing wounds. Marjolins ulcer is a rare, aggressive condition that. Marjolins ulcer is a malignant lesion observed in chronic wounds and in areas where the integrity of the skin is compromised because of any one of several reasons. Marjolins ulcer is part of a group of neoplasms arising in chronic skin lesions, whether inflammatory or traumatic. It most frequently takes the form of squamous cell carcinoma which sometimes is diagnosed during. Introduction marjolin s ulcer is a malignant transformation of traumatized or chronically inflamed cutaneous tissue that occurs most frequently after burns 16.
One sinus was found in the anus, and another in the vagina. Marjolin ulcer in a surgical scar mdedge dermatology. Cases occurring as soon as 3 years after burn healing is complete and as many as 60 years after have been reported. Marjolins ulcer refers to malignant degeneration in a chronic wound. Late presentation has been reported to be typical of these cancers and some of the reasons adduced for this, are difficulties in both clinical and pathological diagnosis. We report a case of marjolins ulcer arising in a posttraumatic chronic ulcer of sole in a 60. Squamous cell carcinoma is the most common variant, and while malignant degeneration usually takes a long time, it can develop acutely. As with other high risk cutaneous cancers, treatment must be planned in the setting of a skin cancer multidisciplinary team. In a patient with chronically irritated skin, good health care will help to prevent a bad outcome such as. Most commonly occurring in the presence of osteomyelitis or burn scars, marjolins ulcers have also been reported with radiotherapy, hidradenitis suppurativa, and diabetic ulcers. Marjolins ulcer is an uncommon malignant condition related to nonhealing wounds, more often of burn injuries. Acute marjolins ulcer in a postauricular scar after.
This article attempts to reveal the importance of the latency period in the prevention and early treatment of the malignancy. Patrick is a 51yearold, recently retired firefighter. Marjolins ulcer is the term given to these aggressive epidermoid tumors that arise from areas of chronic injury, with. This entity is frequently overlooked and therefore inadequately treated leading to a poor prognosis.
Because mri is superior in showing the margins and tissue destruction, it should be the first choice for marjolins ulcer evaluation. Is often used to describe the formation of neoplastic changes in the scar tissue of chronic ulcer,s. The reported latency period for the development of malignancy is between 11 and 75 years,5,15 with an average of 30 to 35 years. We read with interest the case report by chiang et al. Squamous cell carcinoma is the most frequently reported in the literature, it appears most frequently in burn scars, although also described in other types of lesions. A 45 years old man who had sustained a burn injury to his right hand 20 years ago come to our dermatology clinic with complaint of a rapidly growing fungating mass in burn scar from 4 months ago fig. Chronic ringworm infestation and marjolins ulcer, an. This article is from medical journal of the islamic republic of iran, volume 27. Marjolins ulcers in the postburned lesions and scars. Cutaneous nonmu scc is related to excessive sunexposure, with fitzpatrick skin. Marjolins ulcers typically take years to develop though, on occasion, acute onset has been documented.
Nicolas marjolin was credited with describing this phenomenon in 1828. Our aim is increase the suspicion index of primary care workers about the risk of squamous cell carcinoma in skin chronic ulcers or scar tissue, mainly in extremities. Marjolins ulcer medical journal of the islamic republic of iran. It grows slowly, but over time it can spread to other parts of your body. The term was first employed by marjolin in 1828 to describe malignant ulcers derived solely from burns,5. In their discussion, the authors eloquently describe the utility of mri in defining the extent of bone destruction, the margins of the lesion, and the associated softtissue mass.
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