Marjolin's ulcer on the nose

Malignancies in scars are generally known as Marjolin's ulcer. The majority of these arise from burn injuries. Although Marjolin's ulcer consists of all kinds of skin cancer, squamous cell carcinoma is the main cancer type reported in the literature. The pathogenesis of this tumor is due to chronic irritation of the effected area and mostly involves the extremities and scalp area. This report presents an unusually located and rare type of Marjolin's ulcer: on the nose and baso-squamotic in type. A 54-year-old man, 33 years after burn, presented with an unhealed ulcer on his nose which had been present for 2 years. The case was managed by tumor excision and a naso-labial transposition flap. To our knowledge, this is the first report of Marjolin's ulcer developing on post-burned skin of the nose.     

Marjolin's ulcer in patients with spinal cord injury

BACKGROUND: The term "Marjolin's ulcer" is now synonymous with malignant transformation, usually ectodermal and rarely mesenchymal, of chronic ulcers, sinus tracts, and burn scars. DESIGN: Literature search and personal experience with 5 patients during a 30-year period in a spinal cord injury center. FINDINGS: Five cases of Marjolin's ulcer diagnosed among approximately 10,000 patients indicate the rarity of the metaplasia. All cases were fatal. CONCLUSIONS: Chronic pressure ulcers of more than 10 years' duration should be biopsied to rule out malignancy, especially with any change in the nature of the ulcer (eg, exuberant granulation and/or bleeding).     

Marjolin's ulcer arising from a laparostomy scar

Marjolin's ulcer is the malignant transformation of a scar, usually as a squamous cell carcinoma. An uncommon presentation form is from a laparostomy scar. A 49-year-old patient that had a laparostomy during the treatment of a necrohemorrhagic pancreatitis in 1987 complained 13 years later of a 20-cm ulcer on the laparostomy scar. A resection of the abdominal wall including the ulcer and a segmental transverse colectomy were performed because of infiltration by an invasive squamous cell carcinoma. Ten months later, axillary lymphadenectomy was performed because of lymph node metastasis. Currently, the patient is free of disease. Lymph node infiltration is frequent in squamous cell carcinoma on Marjolin's ulcer and survival is not good. Prophylaxis of this disease includes meticulous care of wounds, with early skin grafts when required and treatment of infections.     

Squamous cell carcinoma in chronic ulcerative lesions: a case report and literature review

A case report and literature review are presented involving a fatal case of squamous cell carcinoma of the lower extremity. The unique aspects of this patient include the young age at presentation (35 years old), and the association with both a burn scar (Marjolin's) ulcer and a draining osteomyelitis fistulus tract. Epidemiologic data for Marjolin's ulcers as well as squamous cell carcinoma associated with draining sinus tracts of osteomyelitis are reviewed, in addition to the recommended management of such patients. The case presented is a reminder of the need to maintain a high index of suspicion for malignant transformation within ulcerative lesions.     

Das maligne „Marjolin Ulcus“ als seltene Komplikation eines thermischen Traumas an der oberen Extremität

The,Marjolin's ulcer" is a malignant lesion which is developed especially at chronic wounds after burn trauma. The latency from primary trauma to the malignant transformation is about 30 years. The lesion is more aggressive than other squamous cell carcinomas. We report on the combined radiation and surgical therapy of an 65-year-old patient with this lesion on the right hand and regional lymph node metastases. The extensive tissue defect after wide excision was reconstructed with a reversal radial forearm flap.     

Marjolin's ulcer

In 1828 John Nicolas Marjolini characterized ulcer with malignant degeneration which developed in scars after burns, but it occurs under varying clinical conditions. Typical feature is the latent period (on average 30 years). It is encountered in 2 forms: a shallow ulcer or exophytic tumour, most frequently on the lower extremities. At the Prague Burn Centre 11 patients were treated since 1978 till 1998. A unique case was a man suffering from congenital form of epidermolysis bullosa who developed Marjolin's ulcer on his foot (histological examination confirmed well differentiated squamous cell carcinoma). After 4 years he died with extreme cachexia and metastatic spread of the tumour, because he refused repeatedly amputation and lymph nodes dissection. To prevent Marjolin's ulcer several recommendations are presented.     

Is surgery an effective and adequate treatment in advanced Marjolin's ulcer?

Malignancies in scars are generally known as Marjolin's ulcers. Between 1999 and 2004, 15 patients with Marjolin's ulcer were treated in our clinic. All lesions were secondary to burns of various causes. We perform a combined approach and aggressive surgery for treatment of Marjolin's ulcer; excision with safe margin, lymphatic dissection, postoperative radiotherapy, chemotherapy and amputation if needed. We think that the scar tissue acts as a barrier for the tumors, which will enlarge. We believe that, if we release this barrier like scar tissue, the virulent the spread of the tumor will be permitted. In this article, we consider whether or not surgical excision alone as recommended in the treatment of Marjolin's ulcers is adequate and effective. An aggressive combined approach is essential for treatment in early stages with high success rate. But there is no consensus for the treatment of advanced disease and results are generally unsuccessful.     

Marjolin's ulcer revisited--basal cell carcinoma arising from grenade fragments? Case report and review of the literature.

BACKGROUND: Marjolin's ulcer is a rare and often aggressive cutaneous malignancy arising in previously traumatized or chronically inflamed skin. METHOD: Case report: A 79-year-old World War II veteran developed basal cell carcinoma (BCC) at the site of a war wound. The tumour developed in relation to several metal grenade fragments. With a disease-free interval of 61 years between injury and onset of complications the patient had one of the longest latency periods of tumour development described so far. RESULTS: Review of the literature reveals only five cases of relation between grenade fragments and malignancy formation. Presence of foreign bodies has been described as possible aetiology for malignancy development. Explosives and additives contain several mutagenic and tumourigenic substances. We hypothesize a causal connection between the grenade fragments and the development of BCC. Considering the long period of latency between injury and tumour development we suggest grenade injury with left fragments in soft tissue to be a new origin of Marjolin's ulcer.     

Two case studies of Marjolin's ulcers in patients referred for management of chronic pressure ulcers.

The term "Marjolin's ulcer" is often used to describe the formation of neoplastic changes in the scar tissue of chronic ulcers. This type of carcinoma is most often seen in postburn scars, but it may be seen in many types of chronic wound scars. The most common cell type is squamous cell carcinoma. Squamous cell carcinomas resulting from Marjolin's ulcers have a much greater tendency to metastasize than squamous cell carcinomas arising from other causes, which makes early diagnosis imperative. The 2 case studies in this article describe Marjolin's ulcers occurring in chronic pressure ulcers, which should alert the clinician to the possibility of malignancy in any long-standing wound with an atypical presentation.     

Management of Marjolin's ulcer in a chronic pressure sore secondary to paraplegia: a radical surgical solution

Marjolin's ulcer refers to malignant degeneration in a chronic wound. 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. We present an interesting case of malignant degeneration in a male paraplegic patient with chronic sacral and ischial pressure sores. By discussing our radical surgical solution to this problem, we aim to highlight the importance of prompt diagnosis.     

Development of Marjolin's ulcer following successful surgical treatment of chronic sacral pressure sore

STUDY DESIGN: Case report. OBJECTIVE: Report of an unusual case, where a Marjolin's ulcer that developed 2.5 years after surgical excision and successful closure. SETTING: Department of Plastic and Reconstructive Surgery and Burn Unit and the Clinic for Spinal Cord Injuries, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. METHODS AND RESULTS: A 22-year-old man sustained a fracture with luxation of the 5th and 6th cervical vertebrae and loss of sensory and motor function after a diving accident (complete C8 lesion). During initial hospitalization, he developed a sacral ulcer, which more or less persisted for 38 years, despite several attempts of surgical and conservative treatment. At this time, the ulcer was finally excised and the wound closed successfully. Two and a half years later, however, the ulcer recurred. Biopsies showed squamous cell carcinoma and computed tomography, and magnetic resonance imaging scans revealed a soft tissue process over the sacral and coccygeal bones and massive destruction of these bony structures. The patient died 11 months later, despite surgical and radiation treatment. CONCLUSION: The present case is unusual because, in spite of surgical excision and successful closure of the wound, the patient developed Marjolin's ulcer 2.5 years later. Yet it illustrates the primary importance of preventing the development pressure sores, of aggressive (surgical) therapy with healing when they do arise and of taking frequent biopsies in longstanding chronic ulcers to procure early diagnosis and treatment.     

Squamous cell carcinoma masquerading as a trophic ulcer in a patient with Hansen's disease

Nonhealing trophic ulcers in leprosy are a common phenomenon, but acute malignant transformations of the same are relatively rare. This study reports on a 35-year-old man previously treated for Hansen's disease with a squamous cell carcinoma involving the right foot with rapid lymphatic spread. He was being treated as a benign trophic ulcer for more than 12 months until he started developing huge inguinal lymph nodes and the ulcer rapidly increased in size. Squamous cell carcinomas are known to occur in ulcers of considerable duration but such rapid growth in such a short duration and rapid lymphatic spread is unusual in Marjolin's ulcer as the lymphatics are usually destroyed because of previous inflammation and scarring.     

A rare case of aggressive squamous-cell carcinoma of the breast skin: Marjolin's ulcer. A case report

Marjolin's ulcer is an epidermoid carcinoma arising in a scar or chronic wound and is characterised by an aggressive course. We present a clinical case of ulcerated skin carcinoma of the breast arising in an 80-year-old woman, who at history taking reported a burn occurring 30 years earlier on the breast skin, with subsequent chronic ulcerative scar formation. The definitive histological examination identified a "squamous-cell carcinoma of the breast skin". We have assessed this case and reviewed the literature on Marjolin's ulcer. The patient presented a metastatic relapse of local disease after aggressive surgical treatment. In the clinical history of patients with chronic ulcers it is important to analyse the morphological changes with biopsies and subsequently with the most appropriate diagnostic techniques for the purposes of early initiation of a therapeutic program, since, in the advanced stages, even an aggressive surgical treatment may prove inadequate.     

Early Marjolin's ulcer in Bureau-Barriere syndrome

Bureau-Barrière syndrome (BBS) describes a rare destructive process affecting skin and bone resulting from an acquired unilateral or bilateral polyneuropathy. Clinically, it is characterized by a triad of symptoms, namely, acral ulcerations, polyneuropathy, and bone lesions. To date, the development of Marjolin's ulcer in the course of BBS has not been described to the authors' knowledge.     

Aggressive Squamous Cell Carcinoma Originating as a Marjolin's Ulcer

Background. Marjolin's ulcer is an epidermoid carcinoma arising in a scar or chronic wound and can have an aggressive course.
Objective. To present a case of squamous cell carcinoma arising in a burn scar with resulting metastases and to discuss Marjolin's ulcer.
Results. The patient continued to have further metastatic disease despite aggressive surgical treatment.
Conclusion. In following patients with chronic ulcers and wounds, it is important to evaluate any changes immediately with biopsies and further imaging studies if indicated in order to treat effectively. Even aggressive surgical intervention will sometimes be inadequate in treating these tumors.     

Post burn Marjolin's ulcer in the natal cleft mimicking anal canal carcinoma: a rare site

Marjolin's ulcer is a recognised complication of burn scars, chronic sinuses, and at sites of chronic irritation. The majority of these wounds occur at either venous ulcer or burn sites, usually in the extremities or the trunk. The only current method for confirming diagnosis is biopsy, which if positive will be followed by wide local excision and skin coverage. This paper reports an unusual case, in which a Marjolin's ulcer presented in the natal cleft 45 years after the initial burn injury. Its presentation mimicked that of an anal canal carcinoma, although detailed workup, which included computed tomography (CT) scan revealed this growth to be separate from the anal canal, albeit in close association. This is an extremely rare site and the study illustrates that squamous cell carcinoma can mimic anal carcinoma unless carefully examined.     

Trapezius myocutaneous flap for reconstruction of a large scalp defect following the excision of postburn scar carcinoma (Marjolin's ulcer).

The successful use of a trapezius myocutaneous flap to cover a large scalp defect resulting from the excision of a postburn Marjolin's ulcer is described. The exposed dura was covered with a good functional and cosmetic result.     

The diagnosis and treatment of carcinomas occurring at the sites of chronic pressure ulcers

Tumours that develop at the sites of pressure ulcers are very aggressive. Removal is thus crucial, but such cases are difficult to diagnose. This paper discusses a rare case of Marjolin's ulcer, which was treated with excision and radiotherapy.     

Basal Cell Carcinoma Arising from Surgical Scars: A Case and Review of the Literature

BACKGROUND: Scar malignancies are generally known as Marjolin's ulcer and the majority of them are epidermoid carcinomas. In addition to epidermoid carcinomas, Basal cell carcinoma (BCC) also can grow in various scars. Basal cell carcinoma cases developing in surgical scars are extremely rare; only 5 cases have been encountered in available English literature. METHOD: A 68-year-old woman who has a BCC originating from a surgical scar due to a previous inguinal hernia operation was presented. CONCLUSION: Trauma has been suggested as one of the etiologic factors for BCC; but the role of trauma or resulting scar in BCC pathogenesis is not known. This unresolved issue can be explained with advanced studies revealing biochemical tissue changes occurring during wound healing and trauma.     

A new concept in the management of Marjolin's ulcers.

Marjolin's ulcers have a grave prognosis, especially when regional nodes are involved. Recent studies suggest such cancers are in an immunologically privileges sites due to the dense scar tissue. The prognosis has been shown to be much worse for tumors not having a round cell infiltrate prior to surgery, as in Marjolin's ulcers. The use of topical 5-fluorouracil (5-FU) induces a round cell infiltrate. Three case reports of large Marjolin's ulcers are presented which were first treated with topical 5-FU. Radical ablative surgery was avoided in these patients with a successful outcome.