By Katherine Kozlowski, Medical Author and Contributor to Vein News and www.VeinsVeinsVeins.com
What is a Marjolin's Ulcer?
A Marjolin’s Ulcer is a tumor that most often arises from areas of chronic inflammation or injury. They are most commonly seen in patients with traumatic/chronic wounds, old burn scars, or venous stasis ulcers.
Classic description of a Marjolin’s Ulcer includes a squamous cell carcinoma (SCC, a type of skin cancer) diagnosis. However, other skin cancers can be reported as Marjolin’s Ulcers.
Marjolin’s ulcers have a higher rate of metastasis and local recurrence than other types of skin cancers.
How common are Marjolin’s Ulcers?
They are rare.
However, patients with venous leg ulcers have a relative risk 5.8 times the average person for developing squamous cell carcinomas.
What are the clinical features of a Marjolin’s Ulcer?
Although Marjolin’s Ulcers present as SCC, the clinical features are not always consistent with a typical SCC (everted edge, exophytic/outward growth, bleeding).
Marjolin’s Ulcers may have an irregular base or margin, excess granulation tissue (under microscopic analysis), or an increase in size of the ulcer despite having treatment.
How do you diagnose a Marjolin’s Ulcer?
The gold standard for diagnosis of a Marjolin’s Ulcer is histological analysis of a biopsy which is positive for SCC.
False positive and false negative rates for Marjolin’s Ulcers are less than 2%.
Management of Marjolin’s Ulcers
Early diagnosis is imperative in management of Marjolin’s ulcers due to the aggressiveness and tendency to metastasize.
Excision and skin grafting is the most common treatment for these types of ulcers.
In more complex cases, such as if bone is exposed, more complex reconstruction with free tissue transfer may be necessary.
In advanced cases, common in developing countries, limb amputation may be necessary to control metastasis.
Reference: Choa, R., Rayatt, S., Majtani, K. Marjolin’s Ulcer. Br Med J 2015; 351.