Marjolin’s Ulcer of the Scalp: A Case Operated with Reconstruction by Advancement Flap Completed by a Skin Graft Performed at the Sominé Dolo Hospital in Mopti (Mali)

Abstract

Introduction: Cutaneous squamous cell carcinoma encompasses about 16% of scalp tumors. They can arise de novo or more often mark the evolution of lesions considered as non-invasive precursors: actinic keratoses and Bowen's disease more rarely, they occur on a burn scar (Marjolin's ulcer). We report a case of invasive squamous cell carcinoma on a burn scar (Marjolin's Ulcer) operated with reconstruction by advancement flap completed by a skin graft performed at the Sominé Dolo hospital in Mopti (Mali). A 62-year-old Malian man consulted for a scalp ulceration that had been evolving for 10 years. The lesion began with small trailing erosion that appeared on a burn scar. There was no notion of initial trauma and the patient had no particular history. Physical examination found a large ulceration (6×4 cm) of parietal seat on the scalp with a fibrinous bottom and a sclerotic border. There was a large left latero -cervical mass measuring 13 x 6 cm. The computed tomography of the skull did not find any bone lesions and that of the latero -cervical mass was in favor of adenopathy. Histological examination of a biopsy fragment confirmed the diagnosis of invasive squamous cell carcinoma. Deep resection removing the tumor with the periosteum exposing the parietal bone was performed. Reconstruction by advancement-rotation flap supplemented by a skin graft was performed. The management of squamous cell carcinoma is based on surgery, which is the reference treatment, against which other treatments must be compared. On the scalp, Rotation-advancement flaps are the preferred one-stage surgical repair technique.