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Marjolin's ulcer

Field	Value
name	Marjolin's ulcer
image	Marjolin ulcer.JPG
caption	Marjolin's ulcer presenting on arm following a burn

Marjolin's ulcer refers to an aggressive ulcerating squamous cell carcinoma presenting in an area of previously traumatized, chronically inflamed, or scarred skin. 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 term was named after French surgeon, Jean-Nicolas Marjolin, who first described the condition in 1828. The term was later coined by J C De Costa.

Presentation

Slow growth, painlessness (as the ulcer is usually not associated with nerve tissue), and absence of lymphatic spread due to local destruction of lymphatic channels.

Museum specimen of Marjolin's' ulcer on the sole of a foot

Histology

Histologically, the tumour is a well-differentiated squamous cell carcinoma. This carcinoma is aggressive in nature, spreads locally and is associated with a poor prognosis. 40% occur on the lower limb and the malignant change is usually painless. This malignant change of the wound happens a long time after initial trauma, usually 10–25 years later. Its edge is everted and not always raised. More recent transcriptional analysis suggests that chronically impeded extracellular matrix turnover and epithelium-to-mesenchyme transitions in neglected scar tissue might give rise to this malignancy.

Diagnosis

Wedge biopsy is the favored method of diagnosis. Tissue specimens obtained should be taken from both the centre and margin of lesion, as the central ulcerated deposits may be necrotic.

Treatment

Treatment is usually surgical, with a wide excision of the lesion; typically a 1 cm margin all around is required.

References

(1999). "Marjolin ulcers: secondary carcinomas in chronic wounds". J South Orthop Assoc.
(December 2000). "Marjolin's ulcer presenting in the neck". J Laryngol Otol.
Freedberg, et al. (2003). ''Fitzpatrick's Dermatology in General Medicine''. (6th ed.). McGraw-Hill. {{ISBN. 0-07-138076-0.
(May 1998). "Burn scar carcinoma. Diagnosis and management". Dermatol Surg.
(2013-10-22). "Varicose Veins and Related Disorders".
(October 2005). "Radical surgical treatment for Marjolin ulcer occurring after chronic osteomyelitis". South. Med. J..
(March 2005). "Images in clinical medicine. Marjolin's ulcer". N. Engl. J. Med..
Paredes F. (February 1998). "[Marjölin ulcer]". Acta Med Port.
The cancer has a 18-38% rate of [[metastasis]].Motley, T., White, K. and Clyde, J. (2014). Squamous cell carcinoma of the foot: A case report. The Foot and Ankle Online Journal, 7(2): 2. [http://faoj.org/2014/06/30/squamous-cell-carcinoma-of-the-foot-a-case-report/]
(January 2017). "Transcriptional Analysis Reveals Evidence of Chronically Impeded ECM Turnover and Epithelium-to-Mesenchyme Transition in Scar Tissue Giving Rise to Marjolin's Ulcer". J Burn Care Res.
(August 2024). "Spatial and Single-Cell Transcriptomics Reveal that Oncofetal Reprogramming of Fibroblasts Is Associated with Malignant Degeneration of Burn Scar". J Invest Dermatol.

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This article was imported from Wikipedia and is available under the Creative Commons Attribution-ShareAlike 4.0 License. Content has been adapted to SurfDoc format. Original contributors can be found on the article history page.

epidermal-nevi,-neoplasms,-and-cysts

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