Marjolin's ulcer

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Marjolin's ulcer
Classification and external resources
Marjolin ulcer.JPG
Marjolin's ulcer presenting on arm following a burn
ICD-10 C44.L12 (ILDS C44.L12)

Marjolin's ulcer refers to an aggressive ulcerating squamous cell carcinoma presenting in an area of previously traumatized,[1] chronically inflamed,[2] or scarred skin.[3]:737[4] They are commonly present in the context of chronic wounds including burn injuries, venous ulcers, ulcers from osteomyelitis,[5] and post radiotherapy scars.

The term was named after French surgeon, Jean-Nicolas Marjolin, who first described the condition in 1828.[6] The term was later coined by J C De Costa.

Appearance[edit]

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.[7]

Characteristics[edit]

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.[6] 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.

Diagnosis[edit]

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[edit]

Treatment is usually surgical, with a wide excision of the lesion; typically a 1 cm margin all around is required. Radiation therapy is also a good alternative in most cases.

References[edit]

  1. ^ Esther RJ, Lamps L, Schwartz HS (1999). "Marjolin ulcers: secondary carcinomas in chronic wounds". J South Orthop Assoc 8 (3): 181–7. PMID 12132863. 
  2. ^ Simmons MA, Edwards JM, Nigam A (December 2000). "Marjolin's ulcer presenting in the neck". J Laryngol Otol 114 (12): 980–2. doi:10.1258/0022215001904545. PMID 11177375. 
  3. ^ Freedberg, et al. (2003). Fitzpatrick's Dermatology in General Medicine. (6th ed.). McGraw-Hill. ISBN 0-07-138076-0.
  4. ^ Phillips TJ, Salman SM, Bhawan J, Rogers GS (May 1998). "Burn scar carcinoma. Diagnosis and management". Dermatol Surg 24 (5): 561–5. doi:10.1016/S1076-0512(98)00022-3. PMID 9598012. 
  5. ^ Smidt LS, Smidt LF, Chedid MB, Bavaresco CS, Chedid MF (October 2005). "Radical surgical treatment for Marjolin ulcer occurring after chronic osteomyelitis". South. Med. J. 98 (10): 1053. doi:10.1097/01.smj.0000182509.78816.7b. PMID 16295826. 
  6. ^ a b Chong AJ, Klein MB (March 2005). "Images in clinical medicine. Marjolin's ulcer". N. Engl. J. Med. 352 (10): e9. doi:10.1056/NEJMicm040020. PMID 15758002. 
  7. ^ Paredes F (February 1998). "[Marjölin ulcer]". Acta Med Port (in Portuguese) 11 (2): 185–7. PMID 9567417.