Marjolin's ulcer on frostbite

Abstract

Malignant skin tumors are known to occur on various forms of scars, chronic ulcerations, inflammations, fistulas and mainly on burn scars after a long latent period [1,2]. The term ‘‘Marjolin’s ulcer’’ is used for these malignant skin tumors arising on chronic wound and irritation sites [3]. The relation between malignant degeneration and thermal burn scars is known to have been defined by Celsus in the first century A.D., for the first time. This situation is named after the French surgeon Jean-Nicholas Marjolin who demonstrated the cellular changes of the ulcerated lesions in the scarred tissue in 1828, but it is claimed that Dupuytren also reported the malignant degeneration in 1839 [3,4]. The latent period between the initial injury and the diagnosis of the malignancy is quite long. Though various time periods have been reported, it is accepted to be longer than 20 years [2,5]. On the other hand, there is a reported case of Marjolin’s ulcer occurring a few months after the initial injury [2,3,6]. The pathogenesis of Marjolin’s ulcer is controversial [3,5,7–11]. The incidence of malignant skin tumors on scarred tissues is 0.1–2.5% and squamous cell cancers constitute the majority [2]. Though half of the cases (49%) are due to burn scars, physical and chemical frostbites, stasis ulcers, osteomyelitic sinuses, amputation stumps, syphilis, lupus vulgaris, hidradenitis suppurativa, vesicovaginal fistulas and lymphogranuloma venereum are among the reported rare causes of Marjolin’s ulcers [12]. Frostbite of the lower extremity, also known as ‘‘trench foot’’, is one of the etiologic factors of Marjolin’s ulcer, but