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,^[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.

[edit] Appearance

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]

[edit] Characteristics

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

[edit] Diagnosis

Biopsy is 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.

[edit] Treatment

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

[edit] References

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