Marjolin's ulcer: A case report of a rare but preventable lesion

Abstract

Marjolin's ulcer (MU) is a rare cutaneous malignancy first described in 1828. MU arises in the setting of injured skin with subsequent chronic scarring or ulceration and eventual malignant transformation. While most cases of MU are associated with burn scars, less common settings have included traumatic wounds, venous stasis ulcers, osteomyelitis and pressure sores. MU may develop at any age but tends to affect older individuals. This is likely due to the typically long latency period from inciting event to malignant transformation, which averages 30 to 35 years. A male predilection exists. Lesions occur at any anatomic site, but the lower extremities and the head and neck region are most frequently affected. The predominant malignancy in MU is squamous cell carcinoma (8090%) followed by cases of basal cell carcinoma and malignant melanoma. The treatment of choice is wide surgical resection. MU is typically an aggressive malignancy with a high recurrence rate and poor 5-year survival. A 70 year-old woman from Togo had suffered a burn injury to the left side of her head many years previously. The wounded skin remained unchanged for decades, but recently developed an enlarging ulcer. Incisional biopsy of the ulcerated tissue resulted in a final diagnosis of keratinizing squamous cell carcinoma. Given the clinical setting, the lesion was deemed consistent with a MU. MU is thought to be a largely preventable form of cutaneous malignancy. Proper wound management, including efforts to minimize infection and healing by secondary intention, substantially reduces the risk of malignant transformation. For this reason, MU has a propensity to affect disadvantaged individuals living in poverty who have limited access to proper or adequate healthcare.