Marjolins ulcers are tumours that most commonly arise from areas of chronic inflammation or injury and develop over many years. A biopsy of the mass revealed invasive squamous cell carcinoma consistent with marjolin ulcer fig. Two years later, dupuytren reported these tumours arising out of chronic ulcer to be of malignant. In terms of histopathological classification, marjolins ulcers now are classified into squamous cell carcinoma, basal cell carcinoma, melanoma. Marjolins ulcer with sinuses included within surgical excision margins. 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. In addition, it can also develop from chronic osteomyelitis, traumatic. Current concepts in the management of marjolins ulcers. Marjolin ulcer is a term for scc arising at the site of chronic inflammation. 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. Introduction histopathology marjolins ulcer is a rare case, which the chronic wound changes into malignant form. We report a case of marjolins ulcer of left hand arising in a scar which was caused by trauma in an elderly male who was a farmer by occupation.
Marjolins ulcer has been classically associated with burns, reported to occur as frequently in 2% of chronic burn scars. In addition, it can also develop from chronic osteomyelitis, traumatic injury, diabetic ulcers, pressure ulcer, and vaccination site. Predisposing factors and histopathological variants of cutaneous squamous cell carcinoma. Table 4 shows the comparison of marjolins ulcer in the same setting comparing three periods of study 20002004, 200052009, and the current study, 20102012. Marjolins ulcer is a rare and often aggressive cutaneous malignancy that arises in previously traumatized or chronically inflamed skin, particularly after burns. Thomas hospital, lambeth palace road, london se1 7eh, england.
It most commonly forms at the site of an old thermal burn scar. Clinicopathological evaluation of marjolin ulcers over two decades. This study was conducted to describe the clinicopathological presentation and treatment outcome of this condition in our local. Marjolin s ulcer is a rare and often aggressive cutaneous malignancy that arises in previously traumatized, degenerated and chronically inflamed skin or scar tissue.
Marjolins ulcer refers to an aggressive ulcerating squamous cell carcinoma presenting in an. Marjolins ulcers typically take years to develop though, on occasion, acute onset has been documented. Late presentation still remains a feature of this pathology even in recent times. The most commonly associated malignancy is squamous cell carcinoma scc but other.
The clinical, histopathologic, and immunohistochemical spectrum of disease. Marjolin s ulcer is a rare but highly aggressive squamous cell cancer that is most often associated with chronic burn wounds. A multidisciplinary approach is necessary before surgical treatment. Marjolins tumor complicating chronic periprosthetic.
Marjolins ulcer is the term given to these aggressive epidermoid tumors that arise from areas of chronic injury, with. It also occurs on healed scar of other wound such as osteomyelitis, trauma etc. Marjolin ulcers can be defined as the malignant changes developed on the previously traumatized or chronically inflamed skin. Pressure ulcer, also known as decubitus ulcer as it often arises from lying down, i. 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. Prognosis improves drastically with early recognition and treatment. Marjolin s ulcer is a rare aggressive cutaneous malignancy that often arises in burns scars following, most common site being lower extremity. Marjolins ulcers are frequently associated with burns or injuries and are seldom the product of surgical intervention 2. 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. Marjolin s ulcer refers to an aggressive ulcerating squamous cell carcinoma presenting in an area of previously traumatized, chronically inflamed, or scarred skin 737 they are commonly present in the context of chronic wounds including burn injuries, varicose veins, venous ulcers, ulcers from osteomyelitis, and post radiotherapy scars. Although many individual case reports exist, no comprehensive evaluation of marjolin s ulcer patients has been conducted in our setting.
Sep 09, 2014 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. Many different imaging studies are used for the diagnosis of marjolins ulcer. Then, in 1903, dacosta introduced the term marjolin ulcer to define the malignancies developed on burned tissue. Histopathologically, marjolin ulcers are mostly diagnosed as squamous cell carcinoma and they need special attention when especially located on the lower. Data concerning demography, type of original skin insult, time interval between original lesion and can cer, cancer histology, and lymph node involvement were. Full article pdf 3 academic content and language evaluation of this article citation of this article corresponding author of this article.
Saeedia muhamad shukry 25 years old typist lady from sulaimani, presents to me on 20th nov. Brigid maguire, locum consultant in dermatopathology, st. Acute marjolins ulcer in a venous ulcercase report dr. Retrospectively, we retrieved 83 records of patients with cancer arising from chronic skin conditions. Its incidence is estimated to range from 1% to 2% of all burn scars. The malignant transformation of an ulcer is most commonly. Acral lentiginous melanoma, rare form of marjolins ulcer. Marjolin s ulcers also follow this system, and there is a positive correlation with the duration of ulceration and chance of malignant transformation.
Inthis article, we will report 83 cases of this disease. It is commonly associated with burn scars, but may develop from pressure sores, chronic venous ulcers, traumatic wounds, osteomyelitis, fistulas, and leprosy ulcers 6, 7, 8. Marjolins ulcer, first described by the late french surgeon jeannicolas marjolin in 1828, is the malignant transformation of longstanding burns, fissures, and ulcers, including leprous neurotrophic ulcers, and other chronically inflamed tissue processes. Pdf marjolins ulcer is a rare, aggressive skin cancer developing in scar tissue, chronic ulcers and. In this report, we describe the case of a female patient who was burned 42 years prior, with a large ulceration on her back. Cutaneous squamous cell carcinoma scc is a malignant tumor that. Marjolins ulcer of the palm in a posttraumatic scar. Squamous cell carcinoma marjolins ulcer arising in a. Marjolin s 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. F2 figure 2 marjolins ulcer with sinuses extending into the thigh and labia majora. About 20 years ago, patrick sustained major burns to his legs while fighting a fire at a local factory.
Clinical features and treatment of 140 cases of marjolins ulcer at a. However, it is also associated with chronic inflammatory states, as in nonhealing wounds, venous ulcers, lupus vulgaris, vaccination scars, snake bite scars, pressure sores, osteomyelitis zones, pilonidal. The tissue viability nurse refers a 72 year old woman with lower limb venous stasis and a six year history of a nonhealing ulcer on her shin figure. 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. Pdf a 45 years old man who had sustained a burn injury to his right hand 20. A biopsy revealed welldifferentiated squamous cell carcinoma associated with. Longstanding burns, fissures, and ulcers that undergo malignant transformation into a variety of malignancies, including squamous cell carcinoma, is commonly referred to as a marjolins ulcer. Histopathologically, marjolin ulcers are mostly diagnosed as squamous cell carcinoma. A 35yearold female patient with a tenyear history of a chronic ringworm infestation had developed a nonhealing ulcer in an area of infestation on the right leg. Marjolins ulcer is the eponym used to describe carcinomatous change occurring at the edge of any longstanding benign ulcer irrespective of cause1. This article attempts to reveal the importance of the latency period in the prevention and early treatment of the malignancy. Marjolins ulcer of the pleural surface within a long.
The gp refers her to the plastic surgery team, where incisional biopsy of the ulcer confirms squamous cell carcinoma scc, consistent with a marjolins ulcer. Predisposing factors and histopathological variants of. The classic description is of an scc,2 but other cancers, such. Sixteen cases were diagnosed and treated as marjolins ulcers.
Marjolin ulcer, commonly seen after burn scar, is a neoplastic change in the scar tissue. Marjolins ulcer definition of marjolins ulcer by medical. Experience from a developing country sanjay ky1, chandan kj2, gautam c3, dipendra ks3, abhinav a 4 and satish k3 1department of endocrine surgery, sgpgims, lucknow, india 2department of general surgery, aiims, patna, india 3department of general surgery, rims, ranchi, india. Biopsy of the ulceration showed a highgrade pleomorphic sarcoma in the marjolin s ulcer. Discussion marjolins ulcer is a rare oftenaggressive malignancy 10. Marjolin s ulcer is a rare, aggressive condition that arises on chronic skin lesions and diseases. We report seven cases seen in 3 years, our previous 5year studies reported. Marjolin s ulcer is the term given to these aggressive epidermoid tumors that arise from areas of chronic injury, with. Full article pdf 3 academic content and language evaluation of this article citation of this article corresponding author of this article publishing process of this article research domain of this article. Emsena great marjolins ulcer of the scalp invading outer calvarial bone and its different treatment with support of medpor.
Experience from a developing country sanjay ky1, chandan kj2, gautam c3, dipendra ks3, abhinav a 4 and satish k3. Cases occurring as soon as 3 years after burn healing is complete and as many as 60 years after have been reported. Chronic ringworm infestation and marjolins ulcer, an. It is well recognized that squamous cell carcinomas of the lung and esophagus can cause humoral hypercalcemia of malignancy secondary to paraneoplastic secretion of parathyroid. Marjolins ulcer medical journal of the islamic republic of iran.
Marjolins ulcer most commonly develops from burn injury 1,2. Five females and seven males, aged 38 to 86 years old, formed the group. Marjolins squamous cell carcinoma of the hallux following. Postburn spontaneous brain fungation caused by infiltrating marjolins ulcer of scalp vishal bhasme 1, manish agrawal 1, nc poonia 1, h bagaria 1, pranay chakotiya 2 1 department of neurosurgery, sms medical college, jaipur, rajasthan, india 2 department of plastic surgery, sms medical college, jaipur, rajasthan, india. Data concerning demography, type of original skin insult, time interval between original lesion and cancer,cancer histology, and lymph node involvement were. Da costa in 1903 first coined the term marjolins ulcer, in tumours arising from simple leg ulcers after j n marjolin who first reported the development of tumors arising in burn scars of long duration in 1828 2. The aim of this study was to define etiology, topography, and histopathology for marjolins ulcer and its surgical management. 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. Histopathology of cutaneous squamous cell carcinoma.
Marjolin s ulcer is a very aggressive and rare skin cancer that has been known to develop in scar tissue from burns, chronic wounds caused by trauma, pressure injuries, venous leg ulcers, lupus, snakebites, hidradenitis suppurativa, and osteomyelitis, as well as in other areas that have been affected by chronic inflammation. Marjolins ulcers at a university teaching hospital in. The most serious longterm burn scar problem is burn scar carcinoma, also called marjolin s ulcer. Marjolins ulcer mu refers to a rare but highly aggressive ulcerating squamous cell carcinoma scc that is most often presented in an area of chronic burn wounds. Radiographs demonstrate a periosteal reaction, with lamellated being the most common, and bone destruction. This article attempts to reveal the importance of the latency period in the prevention and early treatment of. An aggressive presentation of exophytic marjolins ulcer and importance of radiotherapy in its treatment discussion etiology of marjolins ulcer is not yet clear. This entity is frequently overlooked and therefore inadequately treated leading to a poor prognosis.
Marjolins ulcer mu is a rare malignancy arising from various forms of. Dec 17, 20 marjolins ulcer mu is a rare malignancy arising from various forms of scars. It grows slowly, but over time it can spread to other parts of your body. Marjolins ulcer refers to an aggressive ulcerating squamous cell carcinoma presenting in an area of previously traumatized, chronically inflamed, or scarred skin 737 they are commonly present in the context of chronic wounds including burn injuries, varicose veins, venous ulcers, ulcers from osteomyelitis, and post radiotherapy scars. Jun 30, 2015 marjolin s ulcer occurs on a previous healed scar or contracture. This potentially fatal complication typically occurs after a certain latency period. A marjolin ulcer is the rare development of cutaneous squamous cell carcinoma scc in the site of a scar or ulcer. In conclusion, marjolins ulcer is a rare but aggressive malignancy.
The mean age of onset is 50 years, and the mean latency at onset is 31 years after injury. This should be suspected when part of an ulcer shows evidence of proliferation. Note deep ulcer and benign appearance of ulcer edges. We report a case of marjolin s ulcer of left hand arising in a scar which was caused by trauma in an elderly male who was a farmer by occupation. One sinus was found in the anus, and another in the vagina. Marjolins ulcer tends to be more aggressive than other types of skin cancer and has a higher regional metastasis and fatality rate. We report here a case of marjolins ulcer developing in a longstanding, inadequately treated, chronic ringworm infestation of the lower limb. Squamous cell carcinoma is the most frequently reported in the literature, it appears most frequently in burn scars, although also described in. Marjolins ulcer is part of a group of neoplasms arising in chronic skin lesions, whether inflammatory or traumatic. The most serious longterm burn scar problem is burn scar carcinoma, also called marjolins ulcer. A marjolin ulcer is a rare and aggressive type of skin cancer that grows from burns, scars, or poorly healing wounds.
Nicolas marjolin was credited with describing this phenomenon in 1828. Marjolins ulcer is a rare aggressive cutaneous malignancy that often arises in burns scars following, most common site being lower extremity. The longstanding ulcers with malignant transformation may cause invasion of different layers of the scalp. Marjolins ulcer is a rare, aggressive cutaneous malignancy that arises primarily in burn scars but can occur in other types of scars. Ct angiography and petct complement mri for evaluating the nature of marjolins ulcers. 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. The authors report twelve cases of marjolin s ulcer that have been diagnosed between 1990 and 2003 at hucffufrj.
When dealing with marjolin s ulcer, the latency period can be misleading since it may occur even after long periods of time than those generally anticipated. To the best of our knowledge, this report is the first to describe a marjolins ulcer in a postauricular surgical scar. Marjolins ulcer is a rare and aggressive form of squamous cell carcinoma scc arising from chronic nonhealing wounds. The depth of tumor invasion should always be specified in the pathology report. Marjolins ulcer is a rare, aggressive skin cancer developing in scar tissue, chronic ulcers and areas affected by inflammations. Firstly, jean nicholas marjolin defined the malignant changes developed on the basis of scar tissue in 1828. Mismanagement introduction marjolins ulcer mu is a malignancy arising in cutaneous scars, chronic wounds, and osteomyelitic sinuses 1. Patrick is a 51yearold, recently retired firefighter. Clinicopathological evaluation of marjolin ulcers over two. The scalp region necessitates additional attention because of the inevitable structures it protects.
Jan 04, 2018 a marjolin ulcer is a rare and aggressive type of skin cancer that grows from burns, scars, or poorly healing wounds. Acute marjolins ulcer in a venous ulcer case report. Marjolins ulcer is an uncommon malignant condition related to nonhealing wounds, more often of burn injuries. Squamous cell carcinoma is the most common variant, and while malignant degeneration usually takes a long time, it can develop acutely. Histopathological diagnosis was poorly differentiated scc for six of the. Acute marjolins ulcer in a postauricular scar after. Marjolins ulcer is a rare, aggressive condition that arises on chronic skin lesions and diseases. Case presentation marjolin,s ulcer complaining of nonhealing ulcer in the lower rt. Sarcomas in marjolin s ulcers are rare, representing approximately 5% of these malignant degenerations. Marjolins ulcer mu is a rare malignancy arising from various forms of scars. However, marjolin ulcers may also form from osteomyelitic lesions and, rarely, venous ulcers, pressure sores, surgical scars, animal bites, and vaccination scars 1. The chest is a common niche for infections, and most aggressive among these infections perhaps is tuberculosis.
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