Background:Marjolin ulcers (MUs) are rare, aggressive cutaneous malignancies that arise from previously injured or chronically inflamed skin. MUs have a poorer prognosis than other types of skin malignancies, with higher nodal metastases and recurrence rates. Although surgical resection remains the primary treatment modality, the management and outcomes of patients with metastatic disease are not well characterized. We reviewed literature on treatment strategies for metastatic MUs and report our institutional experience so as to stimulate interest in this difficult-to-treat entity.Methods:A systematic review on metastatic MUs following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed using the English-language literature. An institutional case series is reported to capture the experience of a rural African hospital.Results:Of 180 publications reviewed, 9 studies with 129 patients, with a mean age of 50.3 years, were included in the study. Burn scars were the most common precursor (54%), with squamous cell carcinoma accounting for 97% of cases. Metastases involved the regional lymph nodes, lungs, and liver. Initial treatment included wide local excision or amputation, with or without adjuvant radiotherapy. Survival data were sparse. Our institutional cohort of 11 patients showed similar patterns of metastases.Conclusions:This review did not identify any effective treatment for metastatic MUs. The current management strategies are largely determined by institutional resource settings, but remain essentially palliative in their approach, highlighting the need for a standardized approach to achieve optimal patient outcomes.

A Marjolin ulcer is a cutaneous malignant growth typically associated with areas of prior injury and irritation, most commonly burn wounds. This case report documents a rare example of a sacral Marjolin ulcer that presented in a patient with a history of lower-back abscesses. There are numerous accounts of this malignancy arising in chronic wounds over many years, but reports of subacute presentations are scarcer. This report underlines the importance of early suspicion and diagnosis in patients who may not have the classic features.

Knowledge, attitude, and practice of healthcare professionals towards the prevention of Marjolin's ulcer in an African suburban tertiary care institution: A cross-sectional study.

Anogenital lichen planus (ALP) is a chronic inflammatory condition associated with significant morbidity and a potential risk of cutaneous squamous cell carcinoma (cSCC), specifically Marjolin ulcer (MU), a rare, but aggressive, life-threatening complication. This systematic review aimed to describe the clinical characteristics of patients developing MU within ALP and its treatment outcomes. MEDLINE and Embase (inception-November 2024) were searched, identifying studies reporting MU or squamous dysplasia arising within ALP lesions. Thirty-two studies (n = 176 cases) were analyzed, including cohort studies, case series, and reports, and a descriptive analysis was performed. Patients had a mean age of 63.9 years, with 77.3% female. ALP lesions were most commonly vulval (72.2%) in females and penile (22.2%) in males. MU or cSCC precursor prevalence in ALP cohorts ranged from 0.9% to 4.2%. Human papillomavirus was rarely detected (8.4%), suggesting other mechanisms underlying MU development. The mean ALP duration prior to squamous dysplasia was 47.5 months. Metastases were present in 45.7% of cases that reported this outcome. MU treatment primarily involved surgical excision, with recurrence in 32.9% of cases and mortality in 21.1%. Poor disease control, erosive morphology, and long-standing lesions were associated with higher malignancy risk. Overall, this review highlights the malignant potential of ALP and underscores the importance of early detection and multidisciplinary care. Routine anogenital examinations, timely biopsies of suspicious lesions, and aggressive management of ALP may improve outcomes. Further research is needed to elucidate the mechanisms underlying MU development and optimize treatment strategies for this rare but morbid complication.

Marjolin ulcer was first mentioned by Celsius in the first century as a malignant transformation of burn scars, which can be caused by chronic wounds. Marjolin ulcer has been observed to have a latent period of over 10 years and occasionally even 36years, with a small number of reports of short latent periods. Squamous-cell carcinoma (SCC) is the most common histology and is often characterized by an ulcerated wound around the injury site with raised margins. Marjolin ulcer squamous-cell carcinoma's poor vascularity makes it difficult for it to respond to chemotherapy and radiotherapy. There is lack of data on acute Marjolin ulcer related to post-traumatic wounds in sub-Saharan Africa. We are reporting on a rare case of acute Marjolin ulcer squamous-cell carcinoma of the lower limb that was treated at Ocean Road Cancer Institute in Tanzania. The authors sought to enhance awareness of acute Marjolin ulcer in low- and middle-income countries. This is a case of a 35-year-old male patient of African origin who was working as an agriculture officer and was involved in a motor bicycle traffic accident 6 years prior at the age of 29years and sustained facial, chest, and right lower limb injuries, which healed by secondary intention 3 months later. A total of 6 months later, he was diagnosed with invasive squamous-cell carcinoma around the lesions in his right knee. The patient was treated with surgery, chemotherapy, and radiotherapy. To our knowledge, this is likely to be the first reported case of acute Marjolin ulcer in East Africa and the third in Africa. This highlights the challenges in diagnosing and managing acute Marjolin ulcer in low- and middle-income countries. The short latent period of acute Marjolin ulcer in Africa necessitates genetic and immunological studies. Where possible, deep chronic wounds should be grafted, while unstable scars should be excised and grafted.

Marjolin's ulcer is an aggressive cutaneous malignancy that arises from chronic, non-healing wounds, with squamous cell carcinoma (SCC) being the most common histologic type. Marjolin's ulcers typically develop from chronic inflammatory states, including scars from chemical burns. We present the case of a 53-year-old woman with a 15 × 17cm Marjolin's scalp ulcer, secondary to recurrent chemical burns from continued permanent wave (perm) treatments. Following work-up, the lesion was diagnosed as cT4N2M0 SCC of the scalp, classifying it as clinical stage IV disease. Due to extensive invasion into the dura, a multidisciplinary surgical intervention was required: surgical oncology for tumor resection with bilateral neck dissections, neurosurgery for craniectomy, craniofacial surgery for cranioplasty, and plastic surgery for finalized closure with a latissimus free flap. This case highlights the importance of a multidisciplinary approach in managing large, invasive Marjolin's ulcers, as well as the rare occurrence of malignant transformation secondary to recurrent perm burns.

Abstract Podiatrists play an integral role in the chronic management of patients with a wide variety of pathologies affecting the skin and toenails of the lower limb. Effective care of dermatology patients often requires support from a wide variety of allied healthcare professionals. We previously identified, in a survey of 247 Irish podiatrists, that over two-thirds of podiatrists (71%, n = 175) reported identifying a lesion that they felt could represent melanoma, but most podiatrists (81.7%, 196 of 240) did not feel they received satisfactory education in melanoma. We aimed to further understand the role podiatrists play in treating patients with chronic skin and nail conditions. We engaged with Podiatry Ireland to design a targeted survey emailed to registered members. Our ethically approved 13-question survey was distributed over a period of 3 months. Our survey received 104 responses. We asked podiatrists to identify the skin and nail conditions they most commonly identified in their clinic; multiple responses were accepted. The most commonly identified presentations were (i) fungal nails (n = 92), (ii) ingrown toenails (n = 85), (iii) corns and callus (n = 82), (iv) diabetic feet (n = 76) and (v) tinea pedis (n = 70). A high proportion of responses identified inflammatory skin conditions such as eczema (n = 51) and psoriasis (n = 40) as commonly seen in their clinics. Overall, 76.9% (n = 80) reported not receiving sufficient education on skin and nail conditions in their undergraduate training. Most (82.6%, n = 86) reported not being familiar with a Marjolin ulcer, while 54.8% (n = 57) reported confidence in advising emollients in patients with dry skin. Approaches to fungal nails and tinea pedis varied, with 47.1% (n = 49) reporting routinely taking nail clippings and conducting skin scrapings within their clinic. In total, 59.6% (n = 62) of podiatrists report advising general practitioner presentation routinely when they clinically suspect a fungal nail infection. Only 4.8% (n = 5) felt as though they received sufficient education in skin and nail conditions in patients with darker skin tones. Seventeen (16.3%) reported feeling comfortable in discussing eczema or psoriasis of the feet with their patients. Nine (8.7%) correctly provided the exact name for the clinical sign ‘Hutchinson’s sign’ from a photograph of a subungual melanoma. Our study demonstrates that many patients with inflammatory skin conditions attend their podiatrist for assistance with management of their condition. A majority of podiatrists do not feel as though they have received sufficient education in skin and nail conditions of the foot, particularly in patients with skin of colour. We advise increased engagement through education with allied healthcare professionals such as podiatrists to ensure patients with skin and nail conditions of the feet are effectively supported, managed and appropriately referred in the community.

A rare presentation of Marjolin ulcer in burn scar in popliteal fossa

Marjolin's ulcer from chronic osteomyelitis.

Heel reconstruction following wide resection of Marjolin ulcer represents a challenge for surgeons. Local or free flaps are usually used, but they present some disadvantages, such as donor site morbidity, high risk of necrosis, and long surgical time and hospital stay. To use a combined multistep protocol of heel reconstruction after wide resection of Marjolin ulcer using a biosynthetic extracellular matrix and negative wound pressure therapy. Demographic, clinical, and surgical data for 4 patients treated at a single institution were retrospectively collected. All patients healed with a good scar appearance and high satisfaction. No complications or tumor recurrence were observed at 12 months postoperative. The findings of this clinical series suggest that the combined protocol described is an effective option for the resolution of these complex wounds.

Reconstructive strategies using abdominal flaps for cutaneous malignancies: A case series.

Marjolin ulcers are aggressive, cutaneous malignancies typically arising from chronic, nonhealing wounds. The presence of an obvious defect often masks this potentially life-threatening condition, making detection difficult and frequently leading to delayed diagnosis. Most cases of Marjolin ulcers are squamous cell carcinoma (SCC) in histology. Unlike for other common cutaneous malignancies, no clear guidelines or protocols are in place for early surveillance and management of Marjolin ulcers. Given the aggressive nature of this malignancy when associated with metastasis, early diagnosis and intervention are imperative. We present a unique case describing an immunocompromised patient with an extensive surgical abdominal history who had developed a cutaneous mass determined to be well-differentiated invasive SCC on final histology. The mass was superimposed over a chronic enteroatmospheric fistula that was present for more than 20 years.

Marjolin ulcer is a malignant degeneration of previously injured skin, long-established scars, and wounds. This malignant transformation is most implicated in full-thickness burns; however, it may be associated with vaccination sites, pressure sores, venous stasis, and many other conditions causing chronic scar or wound formation. These lesions are aggressive and carry a poor prognosis. FDG PET/CT is an excellent diagnostic aid to differentiate these lesions from benign inflammation, to evaluate the primary malignant site and its extent and depth, and to evaluate metastasis. SUV max has been noted to be significantly higher in Marjolin ulcer than in benign conditions.

18 Cutaneous squamous cell carcinoma (Marjolin Ulcers): early identification in old wounds

Abstract Background: Marjolin ulcer is a malignant transformation arising from chronic ulcers or scars from previously traumatized tissues that occur usually after burns. This study aims to study the histopathological profile of a suspected Marjolin ulcerat a major burn center in Bangladesh. Methods: A retrospective analysis of all suspected Marjolin ulcer patients presented at theNational Institute of Burn and Plastic Surgery, Dhaka, Bangladesh from 2020 to 2024 was done. A total of 92 patients of all age groups were included in the study. Results: Most of the patients were between 31-60 years with an overall male preponderance. The most common cause for Marjolin ulcer was burn scars followed by trauma. Lower extremities were found to be the most predominant site. The latency period for the development of Marjolin ulcer was more than 20 years in most of the cases. Squamous cell carcinoma was the most common histological subtype. Conclusion: Chronic non-healing ulcers or scars from previous trauma that do not respond to treatment should be carefully examined for malignant transformation. Histopathologically, these Marjolin ulcers in most of cases are squamous cell carcinoma.

Background. Heel reconstruction following wide resection of Marjolin ulcer represents a challenge for surgeons. Local or free flaps are usually used, but they present some disadvantages, such as donor site morbidity, high risk of necrosis, and long surgical time and hospital stay. Objective. To use a combined multistep protocol of heel reconstruction after wide resection of Marjolin ulcer using a biosynthetic extracellular matrix and negative wound pressure therapy. Materials and Methods. Demographic, clinical, and surgical data for 4 patients treated at a single institution were retrospectively collected. Results. All patients healed with a good scar appearance and high satisfaction. No complications or tumor recurrence were observed at 12 months postoperative. Conclusion. The findings of this clinical series suggest that the combined protocol described is an effective option for the resolution of these complex wounds.

BackgroundCutaneous squamous cell carcinoma (cSCC) is characterized by a high tumor mutational burden due to solar damage and a favorable response to anti-PD-1 immunotherapy. Yet, we encounter tumors arising in areas with minimal sun exposure, such as cSCC that develops in chronically inflamed skin, also known as Marjolin’s Ulcer (MU). The response of MU-SCC to immunotherapy remains unknown.MethodsWe performed a retrospective analysis of patients diagnosed with cSCC and treated with cemiplimab or pembrolizumab in a single tertiary medical center. Patients lost to follow up were excluded.ResultsOf the 84 eligible patients, 9 (11%) had MU-SCC. Of these, 2 (22%) reached partial response (PR), and none reached complete response (CR). In contrast, of the 75 patients with solar damage-related cSCC, 40 had PR (53%), and 20 had CR (26%). The difference between the two subtypes was significant (P < .001). Interestingly, 3 patients with MU-SCC received a second-line chemo-immunotherapy and experienced a partial response that continued for 5 to 21 months. Patients with MU-SCC had a significantly shorter median time to progression (TTP) (1.6 vs 51.6 months, P < .001) and progression-free survival (PFS) (1.6 vs 15.4 months, P < .001). Overall survival (OS) was not significantly shorter (17.4 vs 36.7 months, P = .096). Multivariate analysis confirmed that MU-SCC is an independent risk factor for shorter TTP (HR 5.5, 95% CI 2.2-14.0, P < .001) and PFS (HR 3.5, 95% CI 1.5-8.1, P = .003).ConclusionsThis study suggests that immunotherapy is less beneficial in SCC-MU. More work is needed to verify our findings and explore other treatment options.

IntroductionThe FOXC2 transcription factor has been tied to a wide range of disease states, serving as a promising prognostic biomarker associated with aggressive basal-like human breast cancers (increased cancer invasion and metastasis). Dysregulation of FOXC2 expression has also been found to promote defects in lymphatic remodeling and hyperplastic lymphedema-distichiasis (LD). Since chronic lymphedema is a forerunner of several malignancies and cancers have been known to arise from poorly healing chronic wounds (e.g., Marjolin ulcers), we examined the effect of Foxc2 dysfunction on skin wound healing.MethodsWe used our splinted excisional wounding model that mimics human-like wound healing on wildtype and Foxc2+/− mice (n = 4), which demonstrate incomplete lymphatic vasculature and lymphatic dysfunction. Wound size was measured over the course of 18 days. Tissue was explanted from both groups at post-operative day (POD) 14 and 18 and stained with Masson’s Trichrome to assess scar formation, Picrosirius Red for dermal integrity, or immunofluorescence to assess lymphatic (LYVE1) cell populations.ResultsWildtype mice completely healed by POD 14, while Foxc2+/−mice did not completely heal until POD18. Scar area of healed Foxc2+/−mice (POD 18) was larger than that of healed wild-type mice (POD 14; p = 0.0294). At POD 14, collagen "bers in the scars of Foxc2+/−mice to be narrower (p = 0.0117) and more highly aligned (p = 0.0110), indicating signi"cantly more "brosis in these mice. Collagen "bers in both groups became longer (p = 0.0116) and wider (p = 0.0020) from POD 14 to 18, indicating a temporal evolution of "brosis. Foxc2+/−mice also had lower numbers of LYVE1+, F4/80+ and CD4+ cells compared to wildtype mice.DiscussionIndividuals over 65 years old are more likely to develop cancer and are highly susceptible to developing chronic wounds. Here, we found that FOXC2, which is tied to cancer metastasis and lymphatic dysregulation, also impairs wound healing and promotes "brotic tissue architecture. With FOXC2 proposed as a potential therapeutic target for cancer metastasis, its downstream systemic effects should be considered against the increased chance of developing nonhealing wounds. Further delineation of the microenvironment, cellular events, and molecular signals during normal and Foxc2-associated abnormal wound healing will improve clinical therapies targeting this important marker.

S2892 Time Heals All Wounds but Not This One: A Case of an Infiltrating Marjolin Ulcer of the Abdominal Wall Causing Colonic Obstruction

Jean-Nicolas Marjolin was a 19th century French anatomist and surgeon. Although not strictly speaking a pivotal figure in history of medicine, he deserves to be known for at least three reasons. He (more or less accurately) described a type of ulcer which is nowadays referred to as Marjolin's ulcer (1828); he had the privilege of operating on the world-famous Charles-Maurice de Talleyrand-Périgord for an anthrax (1838); and a rose has been named after him since 1860.