Marjolin's ulcer as the result of post-burn scar transformation

Abstract

Aim: To present six clinical cases of post-burn scar ulcerations and transformations into Marjolin’s ulcer – a rare type of squamous cell carcinoma. Method: Marjolin’s ulcer is a squamous cell carcinoma that occurs in the area of chronically wounded or scarred skin. It is a locally spreading aggressive tumor that has a high metastatic potential with the malignant change occurring approximately 10-25 years after the initial injury. Clinically, in about half of the cases, ulceration occurs on the lower limb, and the ulcer can close and reopen repeatedly. Clinically, Marjolin’s ulcer presents as painful ulceration in the hypertrophic scar and is associated with foul-smelling pus, crusting, and bleeding. As the lymphatic vessels undergo local destruction, there is an absence of exudation and the appearance of a dry wound bed. The tumor edge is everted and not always raised as in the other forms of squamous cell carcinoma. Results / Discussion: The treatment of Marjolin’s ulcer is similar to that of squamous cell carcinomas. Wide excision of the lesion with 1 cm safe margins all around is required, with radial removal being the aim. The depth of the excision depends on the depth of the ulceration. In our six presented clinical cases, the defects after the excision were closed using either skin split thickness flaps or local flap rotation. Conclusion: The ulceration of post-burn scar on the lower extremity should always be closely investigated with the biopsy being essential for the diagnosis. Tissue specimens should be obtained from the margins and center of the lesion. A meticulous follow-up of the ulceration is necessary in the case of a negative diagnosis.