Marjolin ulcer

What is marjolin? ulcer?

A Marjolin ulcer is the rare development of cutaneous scaly cell carcinoma (SCC) on the site of a scar or ulcer Most commonly forms at the site of an old thermal burn scar. However, Marjolin ulcers It can also form from osteomyelitic lesions and, rarely, venous ulcers, pressure ulcers, surgical scars, animal bites and vaccination scars [1].

Who gets Marjolin ulcers?

Marjolin ulcers occur on average around 30 years after a skin lesion resulting in a scar or ulcer (range 10-75 years) [2]. Rarely, a acute Marjolin ulcer can develop between 6 weeks and 1 year of injury. It is estimated that around 2% from thermal burn scars and 0.7% from osteomyelitic lesions become Marjolin ulcers. [3].

Marjolina ulcer can affect people of all ages, most often between 40 and 60 years. Men are 2-3 times more likely to be diagnosed with Marjolin's ulcer than women [4]. All races and skin types can develop Marjolin ulcers.

The most common sites for Marjolin ulcers are the legs and feet. Ulcers can also form on the head and neck. [one].

What causes Marjolin ulcer?

The exact reason why Marjolin ulcers develop is unknown. Most theories suggest that injury and scar formation lead to destruction of local blood and lymphatic vessels, making the area a privileged immune site. This protects the scar from antitumor antibodies and allows transformation and evil one Degeneration of the skin. Chronic inflammation, irritation or trauma The area is also believed to contribute to the process [2].

What are the clinical characteristics of Marjolin's ulcer?

Marjolin's ulcer usually presents as a non-healing sore. Can constantly increase in size, have excess granulation tissue, foul-smelling pus, bleeds easily on contact, and is painful [5].

On examination, Marjolin's ulcers are generally flat and indurated (hardened), with high margins. A less common, less aggressive type of Marjolin's ulcer is slow growing and presents as an exophytic papillary ulcer, which grows outward with finger-like projections. [3, 6].

How is Marjolin ulcer diagnosed?

A Marjolin ulcer should be suspected when the ulcer persists for more than 3 months at the scar site. [two].

The diagnosis is by incision. biopsy of suspected areas of the ulcer. A cancerous change is detected in histological examination of the sample. This may require a multidisciplinary approach, as Marjolin's ulcer can be misdiagnosed as pseudoepitheliomatous hyperplasia [7].

Magnetic resonance imaging (Magnetic resonance) can be done to assess the degree of Soft fabric and bone involvement [8].

Which is the differential diagnosis for Marjolin ulcer?

Differential diagnoses for Marjolin's ulcer include ulcers or skin cancers resulting from other conditions. These include:

• Recurrent Squamous cell carcinoma of the skin at the site of a previously removed carcinoma
• Basal cell carcinoma or other Cancer (e.g, melanoma or sarcoma) at the site of a scar; Sometimes they are called Marjolin's ulcer.

• Diabetic foot ulcer: They are often painless and surrounded by thickened skin.

• Venous ulcer: tend to be irregular and superficial, surrounded by hyperpigmentation because capillary leakage.

• Arterial ulcer: they are more painful in the elevation of the foot, with perforated edges; the patient may have cramps when walking.
• Pyoderma gangrenous: they start as a blister or pustule at the site of a minor injury, and it becomes painful, purulent and dark purple with a protruding edge.

What is the treatment for Marjolin ulcer?

Marjolin's ulcer is usually treated by a large local excision [two]. Aggressive cancer patients may have sentinel lymph node biopsy. Injuries involving the bone require amputation. Mohs surgery can also be performed, although this is rare because of the time, expense, and experience required [9].

Radiotherapy and chemotherapy they have not been shown to be effective in the treatment of Marjolin ulcers. However, radiation therapy can be used to alleviate cases where surgery is not possible or rejected [3].

Patients diagnosed with Marjolin ulcer require long-term follow-up, at least for 3 years. [10].

What is the result of Marjolin ulcer?

Marjolin's ulcers are classified as other cutaneous SCCs, using TNM (tumor, ganglion, metastasis) classification system. This depends on the size of the injury and to what extent has it metastasized to lymph nodes and other organs Forecast it depends more strongly on whether the cancer has already spread to the lymph nodes [11].

The overall 3-year survival for Marjolin's ulcer is 65 to 75%, and the 10-year survival is 34%. A quarter of the patients with ulcers present who have already metastasized, for whom the 3-year survival is 35-50% [2].

Reappearance after surgery it is common, at a rate of 20-30% in 3 years [2].