Marjolin's ulcers: the lasting effect of landmines in Cambodia

Abstract

Background: Marjolin’s ulcer is a rare malignancy often associated with burn scars, traumatic wounds and chronic infections. Cambodia is still contaminated with landmines and unexploded ordinance, and a significant number of people suffer from related injuries, as well as latent development of Marjolin’s ulcers. Objectives: Report on the incidence of suspected and histopathologically confirmed cases of Marjolin’s ulcers at the Children’s Surgical Centre (CSC), Phnom Penh, Cambodia. Comment on 2 similar cases of landmine injuries to the lower limb resulting in Marjolin’s ulcers. Methods: Independent retrospective analysis of electronic and hardcopy patient records (January 2003 to January 2012) was performed by two examiners. Patients were selected based on primary and secondary inclusion criteria. Results: Forty-eight patients were selected from the initial analysis and of those selected, 8 patients met secondary inclusion criteria. From these 8 cases, the preceding pathology included burns (62.5%), landmine blast injuries (25%) and chronic infection (12.5%). Conclusion: The high prevalence of landmine blast victims in Cambodia suggests that there is likely to be a correspondingly high incidence of Marjolin’s ulcers in the population. Improved surveillance for malignancy and prompt intervention in these patients may improve outcomes. Keywords: Cambodia, landmine, Marjolin’s ulcer, squamous cell carcinoma