Marjolin,s ulcer

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Marjolin,s ulcer

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The term marjolin,s ulcer

• Is often used to describe the formation of
  neoplastic changes in the scar tissue of chronic
  ulcer,s

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Chronic wounds scar tissues are prone to an
increased risk of skin cancer
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In1828 jean -Nicholas marjolin described the
occurrence of tumors in post- traumatic scar
tissue
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Marjolin,s ulcer occurs in

• Old burn scars
• osteomyelitis
• frost bite
• venous stasis ulcers
• gun shot wounds
• dog bites
• injection sites
• scar tissue around colostomies

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The latency period between the injury the
appearance of cancer is 25 to 40 years
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The commonest type of carcinoma arising from
marjolin ulcer is

• SCC
• BCC
• MM
• osteogenic sarcoma
• fibrosarcima
• liposarcoma

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The condition is found three times more
frequently in men than women
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Marjolin ulcer occurs

• 40 of cases in the lower extremities
• 30 in the head neck region
• 20 in the upper extremities
• 10 in the trunk
• especially in flexion creases

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Interesting observation is that

• The latency period is inversely proportional to
  the patient age at the time of burn

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The younger patient at the time of injury

• The longer interval for malignant change

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The older the patient at the time of burning

• The shorter the interval for malignant change

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The mechanism of tumor development

• Insufficiency of immunity
• insufficiency of blood flow to scar tissue
• chronic irritation
• burn,s who were left to heal secondary

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The incidence of marjolin ulcer as high as 2/1000
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The changes in old burn scars may suggest
malignancy

• Increase the size of the ulcer
• change in appearance , elevated borders or
  durations
• bad odor pain
• exudates blood drainage
• bon destruction can be seen by radiography
• non healing of an ulcer treated appropriate

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• The most common cell type is squamous cell
  carcinoma

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• For differential diagnosis ,multiple biopsies
  must be taken from the sides centre of the
  lesion.

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• Squqmous cell carcinoma resulting from marjolin
  ulcer Have much greater tendency to metastasize
  (more aggressive )than s c c arising from other
  causes .

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Lymphadenopathies

• Can be observed in up to 30 of marjolin ulcers

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Treatment is based on prevention by

• Correct management of the initial burns
• Cure of any instable scar regular surveillance
• Skin grafting of the burn sites
• Excision of chronic ulcer reconstructed

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Treatment

• Must be radical aggressive
• Wide excision with 3-4cm of the normal skin
• Muscle fascia should be included
• Amputation is recommended for lesions that have
  entered joint cavities metastasized to bone
  tissue in extremities
• Lymph node dissection is recommended

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Performing the excision with

• Cautery is said to be safer as it can prevent
  metastasis

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conclusion

• Chronic ulcer present for decades in developing
  countries
• Patients only consult physicians when they have
  developed complications such pain , bleeding ,or
  tissue necrosis

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