Marjolin ulcers reflect malignant degeneration within pre-existing scars or areas of chronic inflammation such as burns or venous ulcers.
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Epidemiology
Incidence is around 1-2% from all burn scars 1,2. The average latency period between initial injury to malignant transformation is 30-35 years. Men are more commonly affected than females.
Diagnosis
Biopsy of the lesion is the gold standard for diagnosis of this condition 3,4. Sentinel node biopsy can be considered as well.
Clinical presentation
Ulcerating, non-healing lesions over a scar should increase suspicion of Marjolin ulcer 1. Other features include foul-smelling lesions, rapid growth, bleeding, and regional lymphadenopathy 1.
Pathology
Pathologically Marjolin ulcers are characterized by malignancy within a cutaneous scar 1 commonly caused by burns or trauma 3. Squamous cell carcinomas are the most common malignancy identified in the vast majority of case (>70%) followed by basal cell carcinoma and melanoma 5. Very rarely, tumors such as fibrosarcoma, liposarcoma, dermatofibrosarcoma, and osteosarcoma have been noted 6. Malignant transformation starts with acanthosis, then basal cell hyperplasia, pseudo-epitheliomatous hyperplasia, atypical basal cell changes, and ends with carcinomatous changes 6.
Treatment and prognosis
Treatment should be aimed at preventing unresected burn wounds to heal by secondary intention. If a Marjolin ulcer is noted, treatment options include Mohs surgery, wide local excision or amputation proximal to the lesion.
History and etymology
French surgeon Jean Nicloas Marjolin described a case series of ulcers which arose from cutaneous scar tissue in 1828 4. In 1903, John Chalmers DeCosta recognized the potential for carcinomatous degeneration in such ulcers, and coined the term ‘Marjolin’s ulcer’, acknowledging Marjolin's initial observation 7.