Marjolin's Ulcers: A Case Series and Literature Review
Background. A Marjolin's ulcer describes malignant degeneration in any chronic wound. The majority of cases arise in burn scars and are often latent for decades.
Materials and Methods. This case series presents 6 patients with an average age of 63 years with Marjolin's ulcers (both acute and chronic). A review of the literature was also undertaken. These cases underscore the aggressive course and poor prognosis associated with Marjolin's ulcers and the importance of recognizing the potential for malignant transformation of a chronic wound.
Results. In the reported cases, the ulcers were found on the upper and lower extremity, flank, and over the sacrum, emphasizing the propensity of these ulcers to arise in nearly any location. Squamous cell carcinoma is the most prevalent malignancy identified in Marjolin's ulcers and was confirmed in all patients in this study. Patients underwent surgical resection, and all patients eventually succumbed to the disease.
Conclusion. Based on observations and a review of the literature, early detection and aggressive management with wide local excision and prompt coverage yield optimal results when treating patients with Marjolin's ulcers.
The earliest observation of malignant changes within burn scar epithelium dates back to the first century by Aurelius Cornelius Celsus. The French academic surgeon Jean-Nicolas Marjolin is honored with the eponym. Marjolin's ulcer classically refers to squamous cell carcinoma arising in thermal burn scars, although the term has more recently been used to describe malignant degeneration in any chronic wound. Marjolin himself simply documented chronic ulcers arising from scar tissue in the first edition of Dictionnaire de Médecine, published in 1828. The association of malignancy and thermal burn scars was first reported in the literature in 1833 by the English surgeon Caesar Hawkins in his article "Warty Tumours of Cicatrices." After Marjolin's death, the term Marjolin's ulcer was first used by Professor Robert William Smith in 1850 and later by Dr. John Chalmer Da Costa and Dr. John Addison Fordyce, which helped establish the eponym in the medical vocabulary.
Upwards of 75% of reported Marjolin's ulcers occur in burn scar sites. The overall rate of malignant transformation in burn scars is no more than 2%. Malignant degeneration has also been reported in chronic ulcers from trauma, frostbite, discoid lupus erythematosus, skin graft sites, pilonidal abscess, pressure ulcer, snakebites, venous stasis ulcers, leprosy ulcers, hidradenitis suppurativa, and osteomyelitis.
Marjolin's ulcer has been seen in all age groups, though the average age of the patient tends to be near 50 at the time of diagnosis. There is a male-to-female ratio of 2:1. Marjolin's ulcers have the ability to develop in almost any anatomical location, although their incidence is highest in the lower extremities. Though rare, malignant degeneration in chronic wounds continues to occur sporadically. The current report examines 6 cases over a 15-year period at the Medical College of Wisconsin (Milwaukee, WI) affiliated hospitals (Table 1). The retrospective review was done in compliance with the Institutional Review Board guidelines. Included are 3 illustrative cases of the series.
Abstract and Introduction
Abstract
Background. A Marjolin's ulcer describes malignant degeneration in any chronic wound. The majority of cases arise in burn scars and are often latent for decades.
Materials and Methods. This case series presents 6 patients with an average age of 63 years with Marjolin's ulcers (both acute and chronic). A review of the literature was also undertaken. These cases underscore the aggressive course and poor prognosis associated with Marjolin's ulcers and the importance of recognizing the potential for malignant transformation of a chronic wound.
Results. In the reported cases, the ulcers were found on the upper and lower extremity, flank, and over the sacrum, emphasizing the propensity of these ulcers to arise in nearly any location. Squamous cell carcinoma is the most prevalent malignancy identified in Marjolin's ulcers and was confirmed in all patients in this study. Patients underwent surgical resection, and all patients eventually succumbed to the disease.
Conclusion. Based on observations and a review of the literature, early detection and aggressive management with wide local excision and prompt coverage yield optimal results when treating patients with Marjolin's ulcers.
Introduction
The earliest observation of malignant changes within burn scar epithelium dates back to the first century by Aurelius Cornelius Celsus. The French academic surgeon Jean-Nicolas Marjolin is honored with the eponym. Marjolin's ulcer classically refers to squamous cell carcinoma arising in thermal burn scars, although the term has more recently been used to describe malignant degeneration in any chronic wound. Marjolin himself simply documented chronic ulcers arising from scar tissue in the first edition of Dictionnaire de Médecine, published in 1828. The association of malignancy and thermal burn scars was first reported in the literature in 1833 by the English surgeon Caesar Hawkins in his article "Warty Tumours of Cicatrices." After Marjolin's death, the term Marjolin's ulcer was first used by Professor Robert William Smith in 1850 and later by Dr. John Chalmer Da Costa and Dr. John Addison Fordyce, which helped establish the eponym in the medical vocabulary.
Upwards of 75% of reported Marjolin's ulcers occur in burn scar sites. The overall rate of malignant transformation in burn scars is no more than 2%. Malignant degeneration has also been reported in chronic ulcers from trauma, frostbite, discoid lupus erythematosus, skin graft sites, pilonidal abscess, pressure ulcer, snakebites, venous stasis ulcers, leprosy ulcers, hidradenitis suppurativa, and osteomyelitis.
Marjolin's ulcer has been seen in all age groups, though the average age of the patient tends to be near 50 at the time of diagnosis. There is a male-to-female ratio of 2:1. Marjolin's ulcers have the ability to develop in almost any anatomical location, although their incidence is highest in the lower extremities. Though rare, malignant degeneration in chronic wounds continues to occur sporadically. The current report examines 6 cases over a 15-year period at the Medical College of Wisconsin (Milwaukee, WI) affiliated hospitals (Table 1). The retrospective review was done in compliance with the Institutional Review Board guidelines. Included are 3 illustrative cases of the series.
SHARE
