Skip to main content
Top
Published in: World Journal of Surgical Oncology 1/2013

Open Access 01-12-2013 | Research

Marjolin’s ulcer: a preventable malignancy arising from scars

Authors: Nanze Yu, Xiao Long, Jorge R Lujan-Hernandez, Kazi Z Hassan, Ming Bai, Yang Wang, Xiaojun Wang, Ru Zhao

Published in: World Journal of Surgical Oncology | Issue 1/2013

Login to get access

Abstract

Background

Marjolin’s ulcer (MU) is a rare malignancy arising from various forms of scars. This potentially fatal complication typically occurs after a certain latency period. This article attempts to reveal the importance of the latency period in the prevention and early treatment of the malignancy.

Methods

A retrospective review of 17 MU patients who underwent surgical procedures between June of 2005 and December 2011 was conducted. Etiology of injuries, latency period, repeated ulceration, and outcomes were recorded. This observational report reveals characteristics of patients who develop MU.

Results

An incidence of 0.7% of MU was found amongst patients complaining of existing scars in our study; burns and trauma were the most common etiology of MU. The mean latency period was 29 years (SD = 19) and the mean post-ulceration period was 7 years (SD = 9). Statistical analysis revealed a negative correlation between the age of patients at injury and the length of latency period (r = −0.8, P <0.01), as well as the lengths of pre-ulceration and post-ulceration periods (r = −0.7, P <0.01).

Conclusions

Patients experience different lengths of pre- and post-ulceration periods during the latency period. Younger patients tend to have a longer latency period. Skin breakdown on chronic scars and chronic unhealed ulcers are two main sources of MU. MU may be preventable with a close surveillance of the ulcer during the latency period.
Appendix
Available only for authorised users
Literature
1.
go back to reference Kerr-Valentic MA, Samimi K, Rohlen BH, Agarwal JP, Rockwell WB: Marjolin’s ulcer: modern analysis of an ancient problem. Plast Reconstr Surg. 2009, 123: 184-191. 10.1097/PRS.0b013e3181904d86.CrossRefPubMed Kerr-Valentic MA, Samimi K, Rohlen BH, Agarwal JP, Rockwell WB: Marjolin’s ulcer: modern analysis of an ancient problem. Plast Reconstr Surg. 2009, 123: 184-191. 10.1097/PRS.0b013e3181904d86.CrossRefPubMed
2.
go back to reference Bozkurt M, Kapi E, Kuvat SV, Ozekinci S: Current concepts in the management of Marjolin’s ulcers: outcomes from a standardized treatment protocol in 16 cases. J Burn Care Res. 2010, 31: 776-780. 10.1097/BCR.0b013e3181eed210.CrossRefPubMed Bozkurt M, Kapi E, Kuvat SV, Ozekinci S: Current concepts in the management of Marjolin’s ulcers: outcomes from a standardized treatment protocol in 16 cases. J Burn Care Res. 2010, 31: 776-780. 10.1097/BCR.0b013e3181eed210.CrossRefPubMed
4.
go back to reference Copcu E, Aktas A, Sisman N, Oztan Y: Thirty-one cases of Marjolin’s ulcer. Clin Exp Derm. 2003, 28: 138-141. 10.1046/j.1365-2230.2003.01210.x.CrossRefPubMed Copcu E, Aktas A, Sisman N, Oztan Y: Thirty-one cases of Marjolin’s ulcer. Clin Exp Derm. 2003, 28: 138-141. 10.1046/j.1365-2230.2003.01210.x.CrossRefPubMed
5.
go back to reference Tio J, Clarkson JHW, Mirsa A, Srivastava S: Malignant change after 18 months in a lower limb ulcer. Br J Plast Surg. 2003, 56: 825-828. 10.1016/j.bjps.2003.08.016.CrossRef Tio J, Clarkson JHW, Mirsa A, Srivastava S: Malignant change after 18 months in a lower limb ulcer. Br J Plast Surg. 2003, 56: 825-828. 10.1016/j.bjps.2003.08.016.CrossRef
6.
go back to reference Marjolin JN: Ulcere. Dictionnaire de Medicine. Vol. 21. 1828, Paris: Becher, 31-50. Marjolin JN: Ulcere. Dictionnaire de Medicine. Vol. 21. 1828, Paris: Becher, 31-50.
7.
go back to reference Huang CY, Feng CH, Hsiao YC, Chuang SS, Yang JY: Burn scar carcinoma. J Dermatolog Treat. 2010, 21: 350-356. 10.3109/09546630903386580.CrossRefPubMed Huang CY, Feng CH, Hsiao YC, Chuang SS, Yang JY: Burn scar carcinoma. J Dermatolog Treat. 2010, 21: 350-356. 10.3109/09546630903386580.CrossRefPubMed
8.
go back to reference Smith RW: Observations upon the warty ulcer of Marjolin. Dublin Quart J Med Sci. 1850, 9: 257-275.CrossRef Smith RW: Observations upon the warty ulcer of Marjolin. Dublin Quart J Med Sci. 1850, 9: 257-275.CrossRef
9.
go back to reference Kowal-Vern A, Criswell BK: Burn scar neoplasms: a literature review and statistical analysis. Burns. 2005, 31 (4): 403-413. 10.1016/j.burns.2005.02.015.CrossRefPubMed Kowal-Vern A, Criswell BK: Burn scar neoplasms: a literature review and statistical analysis. Burns. 2005, 31 (4): 403-413. 10.1016/j.burns.2005.02.015.CrossRefPubMed
10.
go back to reference MacNalty SAS: British Medical Dictionary. 1961, London: Butterworth, 876- MacNalty SAS: British Medical Dictionary. 1961, London: Butterworth, 876-
11.
go back to reference Cobey FC, Engrav LH, Klein MB, Isom CN, Byrd DR: Brief report: sentinel lymph node dissection and burn scar carcinoma sentinel node and burn scar carcinoma. Burns. 2008, 34 (2): 271-274. 10.1016/j.burns.2006.09.006.CrossRefPubMed Cobey FC, Engrav LH, Klein MB, Isom CN, Byrd DR: Brief report: sentinel lymph node dissection and burn scar carcinoma sentinel node and burn scar carcinoma. Burns. 2008, 34 (2): 271-274. 10.1016/j.burns.2006.09.006.CrossRefPubMed
12.
go back to reference Arons MS, Lynch JB, Lewis SR, Blocker TG: Scar tissue carcinoma. I. A clinical study with special reference to burn scar carcinoma. Ann Surg. 1965, 161: 170-188. 10.1097/00000658-196502000-00003.PubMedCentralCrossRefPubMed Arons MS, Lynch JB, Lewis SR, Blocker TG: Scar tissue carcinoma. I. A clinical study with special reference to burn scar carcinoma. Ann Surg. 1965, 161: 170-188. 10.1097/00000658-196502000-00003.PubMedCentralCrossRefPubMed
13.
go back to reference Phillips TJ, Salman SM: Burn scar carcinoma. Dermatol Surg. 1998, 22: 561-565. Phillips TJ, Salman SM: Burn scar carcinoma. Dermatol Surg. 1998, 22: 561-565.
14.
go back to reference Turegun M, Nisanci M, Guler M: Burn scar carcinoma with longer lag period arising in previously grafted area. Burns. 1997, 23: 496-497. 10.1016/S0305-4179(97)00041-7.CrossRefPubMed Turegun M, Nisanci M, Guler M: Burn scar carcinoma with longer lag period arising in previously grafted area. Burns. 1997, 23: 496-497. 10.1016/S0305-4179(97)00041-7.CrossRefPubMed
15.
go back to reference Baldursson BT, Hedblad MA, Beitner H, Lindelöf B: Squamous cell carcinoma complicating chronic venous leg ulceration: a study of the histopathology, course and survival in 25 patients. Br J Dermatol. 1999, 140: 1148-1152. 10.1046/j.1365-2133.1999.02879.x.CrossRefPubMed Baldursson BT, Hedblad MA, Beitner H, Lindelöf B: Squamous cell carcinoma complicating chronic venous leg ulceration: a study of the histopathology, course and survival in 25 patients. Br J Dermatol. 1999, 140: 1148-1152. 10.1046/j.1365-2133.1999.02879.x.CrossRefPubMed
16.
go back to reference Dupree MT, Boyer JD, Cobb MW: SC arising in a burn scar. Cutis. 1998, 6: 49-51. Dupree MT, Boyer JD, Cobb MW: SC arising in a burn scar. Cutis. 1998, 6: 49-51.
17.
go back to reference Gül U, Kiliç A: Squamous cell carcinoma developing on burn scar. Ann Plast Surg. 2006, 56: 406-408. 10.1097/01.sap.0000200734.74303.d5.CrossRefPubMed Gül U, Kiliç A: Squamous cell carcinoma developing on burn scar. Ann Plast Surg. 2006, 56: 406-408. 10.1097/01.sap.0000200734.74303.d5.CrossRefPubMed
18.
go back to reference Nthumba PM: Marjolin’s ulcers: theories, prognostic factors and their peculiarities in spina bifida patients. World J Surg Oncol. 2010, 8: 108-10.1186/1477-7819-8-108.PubMedCentralCrossRefPubMed Nthumba PM: Marjolin’s ulcers: theories, prognostic factors and their peculiarities in spina bifida patients. World J Surg Oncol. 2010, 8: 108-10.1186/1477-7819-8-108.PubMedCentralCrossRefPubMed
19.
go back to reference Fairbairn Hill BB, Sloan DA, Lee EY, McGrath PC, Kenady DE: Marjolin’s ulcer of the foot caused by nonburn trauma. South Med J. 1996, 89 (7): 707-710. 10.1097/00007611-199607000-00011.CrossRef Fairbairn Hill BB, Sloan DA, Lee EY, McGrath PC, Kenady DE: Marjolin’s ulcer of the foot caused by nonburn trauma. South Med J. 1996, 89 (7): 707-710. 10.1097/00007611-199607000-00011.CrossRef
20.
go back to reference Fairbairn NG, Hamilton SA: Management of Marjolin’s ulcer in a chronic pressure sore secondary to paraplegia: a radical surgical solution. Int Wound J. 2011, 8 (5): 533-536. 10.1111/j.1742-481X.2011.00831.x.CrossRefPubMed Fairbairn NG, Hamilton SA: Management of Marjolin’s ulcer in a chronic pressure sore secondary to paraplegia: a radical surgical solution. Int Wound J. 2011, 8 (5): 533-536. 10.1111/j.1742-481X.2011.00831.x.CrossRefPubMed
21.
go back to reference Lawrence EA: Carcinoma arising in the scars of thermal burns. Surg Gynecol Obstet. 1952, 95: 579-588.PubMed Lawrence EA: Carcinoma arising in the scars of thermal burns. Surg Gynecol Obstet. 1952, 95: 579-588.PubMed
22.
go back to reference Mosborg DA, Crane RT, Tami TA, Parker GS: Burn scar carcinoma of the head and neck. Arch Otolaryngol Head Neck Surg. 1988, 114: 1038-1040. 10.1001/archotol.1988.01860210104027.CrossRefPubMed Mosborg DA, Crane RT, Tami TA, Parker GS: Burn scar carcinoma of the head and neck. Arch Otolaryngol Head Neck Surg. 1988, 114: 1038-1040. 10.1001/archotol.1988.01860210104027.CrossRefPubMed
23.
go back to reference Smith J, Mello LF, Nogueira Neto NC, Meohas W, Pinto LW, Campos VA, Barcellos MG, Fiod NJ, Rezende JF, Cabral CE: Malignancy in chronic ulcers and scars of the leg (Marjolin’s ulcer): a study of 21 patients. Skeletal Radiol. 2001, 30: 331-337. 10.1007/s002560100355.CrossRefPubMed Smith J, Mello LF, Nogueira Neto NC, Meohas W, Pinto LW, Campos VA, Barcellos MG, Fiod NJ, Rezende JF, Cabral CE: Malignancy in chronic ulcers and scars of the leg (Marjolin’s ulcer): a study of 21 patients. Skeletal Radiol. 2001, 30: 331-337. 10.1007/s002560100355.CrossRefPubMed
24.
go back to reference Ozek C, Celik N, Bilkay U, Akalin T, Erdem O, Cagdas A: Marjolin’s ulcer of the scalp: report of 5 cases and review of the literature. J Burn Care Rehabil. 2001, 22 (1): 65-69. 10.1097/00004630-200101000-00013.CrossRefPubMed Ozek C, Celik N, Bilkay U, Akalin T, Erdem O, Cagdas A: Marjolin’s ulcer of the scalp: report of 5 cases and review of the literature. J Burn Care Rehabil. 2001, 22 (1): 65-69. 10.1097/00004630-200101000-00013.CrossRefPubMed
25.
go back to reference Enoch S, Miller DR, Price PE, Harding KG: Early diagnosis is vital in the management of squamous cell carcinomas associated with chronic non healing ulcers: a case series and review of the literature. Int Wound J. 2004, 1: 165-175. 10.1111/j.1742-4801.2004.00056.x.CrossRefPubMed Enoch S, Miller DR, Price PE, Harding KG: Early diagnosis is vital in the management of squamous cell carcinomas associated with chronic non healing ulcers: a case series and review of the literature. Int Wound J. 2004, 1: 165-175. 10.1111/j.1742-4801.2004.00056.x.CrossRefPubMed
26.
go back to reference Bauer T, David T, Rimareix F, Lortat-Jacob A: Marjolin’s ulcer in chronic osteomyelitis: seven cases and a review of the literature. Rev Chir Orthop Reparatrice Appar Mot. 2007, 93: 63-71.CrossRefPubMed Bauer T, David T, Rimareix F, Lortat-Jacob A: Marjolin’s ulcer in chronic osteomyelitis: seven cases and a review of the literature. Rev Chir Orthop Reparatrice Appar Mot. 2007, 93: 63-71.CrossRefPubMed
27.
go back to reference Papadopoulos O, Frantzoglou M, Chrisostomidis C, Konofaos P, Frangoulis M, Barlas G: Neglected squamous cell carcinoma of the frontal area: a clinical report. J Craniofac Surg. 2006, 17: 1015-1020. 10.1097/01.scs.0000234983.61745.38.CrossRefPubMed Papadopoulos O, Frantzoglou M, Chrisostomidis C, Konofaos P, Frangoulis M, Barlas G: Neglected squamous cell carcinoma of the frontal area: a clinical report. J Craniofac Surg. 2006, 17: 1015-1020. 10.1097/01.scs.0000234983.61745.38.CrossRefPubMed
28.
go back to reference Copcu E: Marjolin’s ulcer a preventable complication of bums. Plast Reconstr Surg. 2009, 124: 156e-164e. 10.1097/PRS.0b013e3181a8082e.CrossRefPubMed Copcu E: Marjolin’s ulcer a preventable complication of bums. Plast Reconstr Surg. 2009, 124: 156e-164e. 10.1097/PRS.0b013e3181a8082e.CrossRefPubMed
29.
go back to reference Emsen IM: A great Marjolin’s ulcer of the scalp invading outer calvarial bone and its different treatment with support of medpor. J Craniofac Surg. 2008, 19: 1026-1029. 10.1097/SCS.0b013e31809eda0d.CrossRefPubMed Emsen IM: A great Marjolin’s ulcer of the scalp invading outer calvarial bone and its different treatment with support of medpor. J Craniofac Surg. 2008, 19: 1026-1029. 10.1097/SCS.0b013e31809eda0d.CrossRefPubMed
30.
go back to reference Ko Y, Han YM, Hwang HS, Lee ES, Lee GK: Role of 18 F-FDG PET/CT in the diagnosis of clinically suspected Marjolin ulcer. AJR Am J Roentgenol. 2012, 199 (6): 1375-1379. 10.2214/AJR.11.8398.CrossRefPubMed Ko Y, Han YM, Hwang HS, Lee ES, Lee GK: Role of 18 F-FDG PET/CT in the diagnosis of clinically suspected Marjolin ulcer. AJR Am J Roentgenol. 2012, 199 (6): 1375-1379. 10.2214/AJR.11.8398.CrossRefPubMed
31.
go back to reference Hansen SL, Mathes SJ: Problem wounds and principles of closure. Plastic Surgery. Edited by: Mathes SJ. 2006, Philadelphia: Saunders Elsevier, 916- Hansen SL, Mathes SJ: Problem wounds and principles of closure. Plastic Surgery. Edited by: Mathes SJ. 2006, Philadelphia: Saunders Elsevier, 916-
32.
go back to reference Tiftikcioglu YO, Ozek C, Bilkay U, Uckan A, Akin Y: Marjolin ulcers arising on extremities. Ann Plast Surg. 2010, 64 (3): 318-320. 10.1097/SAP.0b013e3181a73064.CrossRefPubMed Tiftikcioglu YO, Ozek C, Bilkay U, Uckan A, Akin Y: Marjolin ulcers arising on extremities. Ann Plast Surg. 2010, 64 (3): 318-320. 10.1097/SAP.0b013e3181a73064.CrossRefPubMed
Metadata
Title
Marjolin’s ulcer: a preventable malignancy arising from scars
Authors
Nanze Yu
Xiao Long
Jorge R Lujan-Hernandez
Kazi Z Hassan
Ming Bai
Yang Wang
Xiaojun Wang
Ru Zhao
Publication date
01-12-2013
Publisher
BioMed Central
Published in
World Journal of Surgical Oncology / Issue 1/2013
Electronic ISSN: 1477-7819
DOI
https://doi.org/10.1186/1477-7819-11-313

Other articles of this Issue 1/2013

World Journal of Surgical Oncology 1/2013 Go to the issue